血浆NGAL水平与稳定性冠心病患者冠状动脉病变程度的相关性研究

Association of neutrophil gelatinase-associated lipocalin and severity of coronary stenosis in patients with stable coronary artery disease

目的探讨稳定性冠心病(stable coronary artery disease,SCAD)患者血浆中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)与冠状动脉病变程度的关系,及其识别冠状动脉狭窄严重程度的能力。方法连续入选因疑似冠心病而首次行冠状动脉造影的患者144例,分为稳定性冠心病(SCAD)组(101例)和非冠心病组(43例),比较两组临床数据。SCAD患者根据Gensini评分3分位数将其分为轻度病变组(Gensini评分<16分,32例)、中度病变组(16分≤Gensini评分<36分,33例)和重度病变组(Gensini评分>36分,35例),比较三组临床数据。采用有序Logistic回归分析冠状动脉重度病变的相关因素。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析比较血浆NGAL水平识别重度冠状动脉病变的能力。结果SCAD患者血浆NGAL、高敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)水平高于非冠心病组(P<0.01);重度病变组患者血浆NGAL、hs-CRP水平高于中度病变和轻度病变组(P<0.01)。多因素回归分析显示,血浆NGAL(OR=1.05)和hs-CRP(OR=1.93)水平是重度冠状动脉病变的独立影响因素(P均<0.05)。ROC曲线分析结果显示,血浆NGAL和hs-CRP识别重度冠状动脉病变的曲线下面积分别为0.771,0.702,差异无统计学意义(P>0.05)。结论血浆NGAL与SCAD患者冠状动脉病变严重程度相关,对严重冠状动脉病变可提供一定的识别能力。

Objective To investigate the association of neutrophil gelatinase-associated lipocalin(NGAL)and severity of coronary stenosis in patients with stable coronary artery disease(SCAD).Methods Totally 144 patients who underwent coronary angiography firstly due to suspected coronary artery disease were enrolled.The patients were divided into SCAD group(n=101)and non-CAD group(n=43),and the clinical data were compared.The SCAD group was fuether divided into three subgroups accoding to Gensini score:mild stenosis group(Gensini<16,n=32),moderate stenosis(16≤Gensini<30,n=33)and severe stenosis group(Gensini≥36,n=35).The clinical data of each group were compared.Odinal Logistic regression was used to analysis the influencing factors of severe stenosis.The receiver operating characteristic(ROC)curve was performed to evaluated the ability of NGAL in discriminating severe stenosis.Results Serum NGAL,high sensitive C-reactive protein(hs-CRP)level in SCAD group were higher than those in non-CAD group(P<0.01).Comparing with mild and moderate stenosis groups,NGAL and hs-CRP level were more higher in severe stenosis group(P<0.01).Multivariable Logistic regression analysis showed that NGAL and hs-CRP were independent risk factors for severe coronary stenosis(both P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the areas under the curve of NGAL and hs-CRP were 0.771,0.702 respectively(both P<0.01).The difference between two AUCs was 0.069 which was insignificant(P>0.05).Conclusion Serum NGAL increased is closely associated with severe coronary stenosis in patients with SCAD,which has a certain ability of discriminating severity of coronary stenosis.