急性冠脉综合征患者血清CRTP5水平与冠状动脉病变程度及心肌纤维化的相关性研究

The correlation between serum CTRP5 level and the degree of coronary artery lesion and myocardial fibrosis in patients with acute coronary syndrome

目的:检测急性冠脉综合征(ACS)患者血清补体C1q/肿瘤坏死因子相关蛋白-5(CTRP5)水平,并分析其与冠状动脉病变程度和心肌纤维化的关系。方法:选择2022年10月—2023年10月在衡水市人民医院心血管内科住院的ACS患者210例,根据临床诊断标准分为不稳定型心绞痛(UA)亚组、非ST段抬高型心肌梗死(NSTEMI)亚组和ST段抬高型心肌梗死(STEMI)亚组;根据冠状动脉造影血管病变支数分为单支病变亚组、双支病变亚组和3支病变亚组;根据Gensini评分分为高评分亚组(>60分)、中评分亚组(31~60分)和低评分亚组(0~30分)。其中的60例ACS患者术后1个月行心脏磁共振检查,根据心血管磁共振-延迟钆增强(CMR-LGE)分为LGE阳性组和LGE阴性组。另选择同期行冠状动脉造影无明显阻塞性狭窄病变的100例患者作为对照组。比较各组全身免疫炎症指数(SII)和血清CTRP5水平。采用logistic回归分析影响冠状动脉病变程度的因素。绘制受试者工作特征(ROC)曲线,分析血清CTRP5水平对冠状动脉病变程度与心肌纤维化的预测价值。结果:与对照组患者比较,UA亚组、NSTEMI亚组和STEMI亚组患者血清CTRP5和SII水平明显升高(均P<0.05),但NSTEMI亚组与STEMI亚组上述指标差异无统计学意义。随着冠状动脉病变支数和Gensini评分的增加,CTRP5与SII水平呈升高趋势(均P<0.05)。LGE阳性组患者入院后CTRP5与SII水平均高于LGE阴性组(均P<0.05)。Logistic回归分析显示,空腹血糖(FBG,OR=1.267,95%CI:1.041~1.544,P=0.019)、SII(OR=1.001,95%CI:1.000~1002,P=0.044)和CTRP5(OR=1.127,95%CI:1.036~1.226,P=0.005)是冠状动脉多支病变的危险因素。ROC曲线显示,血清CTRP5预测冠状动脉多支病变的曲线下面积(AUC)为0.708,灵敏度为81.4%,特异度为78.9%,截断值为10.31 ng/mL;预测心肌纤维化的AUC为0.775,灵敏度为64.7%,特异度为92.3%,截断值为11.10 ng/mL。结论:ACS患者血清CTRP5水平升高,其水平对冠状动脉病变程度尤其是多支病变及心肌纤维化均具有较好的预测价值。

Objective To analyze the relationship between serum complement C1q/tumor necrosis factor-related protein 5(CTRP5) level and the severity of coronary artery disease and myocardial fibrosis in patients with acute coronary syndrome(ACS).Methods A total of 210 patients with ACS hospitalized in the Department of Cardiology, Hengshui People's Hospital from October 2022 to October 2023 were selected. All patients were divided into the unstable angina pectoris(UA) subgroup, the non ST-segment elevation myocardial infarction(NSTEMI) subgroup, and the ST-segment elevation myocardial infarction(STEMI) subgroup according to clinical diagnostic criteria. Patients were divided into the single-vessel disease subgroup, double-vessel disease subgroup, and three-vessel disease subgroup based on the number of coronary artery lesions. Patients were divided into the high-score subgroup(>60 points), middle-score subgroup(31-60 points), and low-score subgroup(0-30 points) according to gensini score. Sixty ACS patients underwent cardiac magnetic resonance examination one month after operation, and were divided into the LGE positive group and LGE negative group according to cardiovascular magnetic resonance-delayed gadolinium enhancement(CMR-LGE). Another 100 patients without obvious obstructive stenosis by coronary angiography were selected as the control group. The systemic immune inflammation index(SII) and serum CTRP5 levels were compared among the groups. Logistic regression analysis was used to analyze the factors affecting the degree of coronary artery disease. The receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of serum CTRP5 on the degree of coronary artery disease and myocardial fibrosis.Results The levels of serum CTRP5 and SII in the UA subgroup, NSTEMI subgroup, and STEMI group were higher than those in the control group(all P < 0.05), but there was no significant difference in CTRP5 and SII levels between the NSTEMI subgroup and the STEMI subgroup. With the increase of coronary artery lesions and Gensini score, CTRP5 and SII levels showed an increasing trend(both P < 0.05). CTRP5 and SII levels in the LGE positive group were higher than those in the LGE negative group(both P < 0.05). Logistic regression analysis showed that fasting blood glucose(FBG, OR=1.267, 95%CI: 1.041-1.544, P=0.019), SII(OR=1.001, 95%CI: 1.000-1002, P=0.044), and CTRP5(OR=1.127, 95%CI: 1.036-1.226, P=0.005) were risk factors affecting the severity of coronary artery disease. ROC analysis showed that the area under the curve(AUC) of CTRP5 in predicting multi-vessel disease was 0.708, the sensitivity was 81.4%, the specificity was 78.9%, and the cut-off value was 10.31 ng/mL. The AUC of CTRP5 in predicting myocardial fibrosis was 0.775, the sensitivity was 64.7%, the specificity was 92.3%, and the cut-off value was 11.10 ng/mL.Conclusion The level of serum CTRP5 in ACS patients is increased and its level has a good predictive value for the degree of coronary artery disease especially for multivessel disease and myocardial fibrosis.