冠状动脉计算机断层扫描血管成像及炎症标志物与急性冠状动脉综合征患者病情及预后的关系

Correlation of Coronary Computed Tomography Angiography and Inflamma⁃tory Markers with the Condition and Prognosis in Patients with Acute Coronary Syndrome

目的分析冠状动脉电子计算机断层扫描(computed tomography,CT)血管成像及炎症标志物与急性冠状动脉综合征(acute coronary syndrome,ACS)患者病情和预后的相关性。方法采取回顾性研究,选择2022年6月至2023年6月南充市中心医院收治的120例经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗患者作为研究对象。所有患者均接受冠状动脉CT血管成像检测[非钙化斑块体积(non-calcified plaque volume,NCPV)、钙化斑块体积(calcified plaque volume,CPV)]及血清炎症标志物检测[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)、CXC趋化因子配体12(CXC chemokine ligand 12,CXCL12)]。统计并比较两组患者的基线资料,采用二元Logistic回归分析对冠状动脉CT血管成像及炎症标志物与ACS患者病情严重程度及预后的关系进行分析。采用样条函数与Logistics回归相结合的限制性立方样条法分析冠状动脉CT血管成像及炎症标志物与ACS患者预后的剂量反应关系。结果重度组病变血管支数≥3支患者占比高于对照组,NCPV、CPV、TNF-α、MCP-1、CXCL12高于对照组,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,病变血管支数≥3支,NCPV、CPV、TNF-α、CXCL12高水平是ACS患者病情为重度的危险因素(OR=3.280、1.014、1.072、3.569、2.595,P<0.05)。预后不良组病变血管支数≥3支患者占比高于预后良好组,NCPV、CPV、TNF-α、MCP-1、CXCL12高于预后良好组,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,病变血管支数≥3支,NCPV、CPV、TNF-α、CXCL12高水平是ACS患者预后不良的危险因素(OR=4.522、1.011、1.120、4.380、1.850,P<0.05)。NCPV、CPV、TNF-α、CXCL12与ACS患者预后不良关联强度呈线性剂量反应关系(P<0.05)。NCPV、CPV、TNF-α、CXCL12与ACS患者预后不良呈正相关,特别当NCPV>36.73 mm3、CPV>36.73 mm3、TNF-α>2.79 ng/mL、CXCL12>8.34 ng/mL时,ACS患者预后不良风险随NCPV、CPV、TNF-α、CXCL12升高而升高。结论冠状动脉CT血管成像NCPV、CPV及炎症标志物TNF-α、CXCL12与ACS患者病情及预后关系密切。

Objectives To analyze the correlation between coronary computed tomography(CT)angiography and inflam⁃matory markers with the condition and prognosis in patients with acute coronary syndrome(ACS).Methods A retrospective study was conducted to select the clinical data of 120 percutaneous coronary intervention(PCI)patients admitted to the Nanchong Central Hospital from June 2022 to June 2023 as the study subjects.All the patients underwent coronary CT angiography[non-calcified plaque volume(NCPV),calcified plaque volume(CPV)]and serum inflammatory markers[tumor necrosis factor-α(TNF-α),monocyte chemoattractant protein-1(MCP-1),CXC chemokine ligand 12(CXCL12)]were tested.The baseline data of the two groups were statistically analyzed and compared.Binary Logistic regression analysis was used to analyze the relationship between coronary CT angiography and inflammatory markers with the severity and prognosis of ACS patients.The receiver operating characteristic curve(ROC)was used to analyze the value of coronary CT angiography and inflammatory markers in the prognosis of ACS patients.The dose-response relationships between coronary CT angiography and inflammatory markers with the prognosis of ACS patients were analyzed by using the restricted cubic spline method combined with spline function and Logistics regression.Results The proportion of patients with more than 3 diseased vessels in severe group was higher than that in control group,and the levels of NCPV,CPV,TNF-α,MCP-1 and CXCL12 were higher than those in control group(P<0.05).Binary Logistic regression analysis showed that the number of diseased vessels≥3,high levels of NCPV,CPV,TNF-αand CXCL12 were risk factors for severe ACS(OR=3.280,1.014,1.072,3.569,2.595,P<0.05).The proportion of patients with≥3 vessels in poor prognosis group was higher than that in good prognosis group,and the levels of NCPV,CPV,TNF-α,MCP-1 and CXCL12 were higher than those in good prognosis group(P<0.05).Binary Logistic regression analysis showed that the number of diseased vessels≥3,high levels of NCPV,CPV,TNF-α,and CXCL12 were risk factors for poor prognosis in ACS patients(OR=4.522,1.011,1.120,4.380,1.850,P<0.05).There was a linear dose-response relationship between NCPV,CPV,TNF-α,and CXCL12 in ACS patients with poor prognosis(NCPV>36.73 mm3,CPV>36.73 mm3,TNF-α>2.79 ng/mL,CXCL12>8.34 ng/mL).The risk of poor prognosis in ACS patients increased with the increase of NCPV,CPV,TNFα,and CXCL12.Conclusions Coronary CT angiography NCPV,CPV and inflammatory markers TNF-α,CXCL12 are closely related to the condition and prognosis of ACS patients.