血小板凝溶胶蛋白及血瘀证计分与急性冠脉综合征患者临床预后的相关性研究
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摘要
目的分析血小板凝溶胶蛋白(gelsolin)水平及血瘀证计分与急性冠脉综合征(acute coronary syndrome,ACS)患者临床预后的相关性。方法连续入选175例ACS患者,术前收集血清标本,检测血小板gelsolin浓度;计算血瘀证计分;随访期6个月,记录主要心血管不良事件(major cardiovascular events,MACE)的发生情况。分析血小板gelsolin水平、血瘀证计分与ACS患者临床预后的相关性及预测ACS不同亚组患者6个月内发生MACE的最佳界值。结果 (1)多因素Logistic回归分析提示血小板gelsolin水平、血瘀证计分是ACS患者6个月内发生MACE的危险因素。(2)当血小板gelsolin水平为282.75、253.20、324.30μg/mL时,分别为预测ACS、不稳定性心绞痛(UA)及急性心肌梗死(AMI)患者6个月内发生MACE的最佳界值。(3)当血瘀证计分为30、26及35分时,分别为预测ACS、UA及AMI患者6个月内发生MACE的最佳界值。(4)血小板gelsolin联合血瘀证计分预测ACS预后的ROC曲线下面积为0.901(95%CI:0.815-0.987,P<0.01),说明血小板gelsolin水平联合血瘀证计分对ACS患者6个月内发生MACE具有较高的预测价值。结论血小板gelsolin水平与血瘀证计分可作为ACS患者短期临床预后的预测指标;血小板gelsolin水平联合血瘀证计分判断ACS预后,具有更高的可靠性。
Objective To explore the correlations of platelet gelsolin level and blood stasis syndrome score with the prognosis for acute coronary syndrome(ACS) patients, so as to provide reference for clinical prognosis of ACS in combination of TCM and Western medicine. Methods A total of 175 ACS patients were successively enrolled, the serum specimens were collected preoperatively, the platelet gelsolin concentrations were detected, and the blood stasis syndrome scores in patients were evaluated. The patients were followed up for 6 months, and the occurrence of major cardiovascular events(MACE) was recorded. To investigate the correlation between platelet gelsolin level, blood stasis syndrome score and clinical prognosis of patients with different subgroups of ACS. Results(1) Multivariate Logistic regression analysis revealed that the platelet gelsolin level and blood stasis syndrome score were the risk factors of the occurrence of MACE within 6 months in ACS patients.(2) When the platelet gelsolin level of 282.75, 253.20 and 324.30 μg/mL were selected as the optimal threshold.(3) When the blood stasis syndrome score of 30, 26 and 35 were selected as the optimal threshold.(4) The AUC of the platelet gelsolin level combined with blood stasis syndrome score in predicting the ACS prognosis was 0.901(95%CI: 0.854-0.949, P<0.01),suggesting that the combination of the two indexes displayed a higher predicting value for ACS prognosis. Conclusions It is speculated that, the platelet gelsolin level and blood stasis syndrome score are positively correlated with the prognosis for ACS. In addition, the combination of platelet gelsolin level with TCM blood stasis syndrome score shows a higher predicting value for ACS prognosis.
Objective To explore the correlations of platelet gelsolin level and blood stasis syndrome score with the prognosis for acute coronary syndrome(ACS) patients, so as to provide reference for clinical prognosis of ACS in combination of TCM and Western medicine. Methods A total of 175 ACS patients were successively enrolled, the serum specimens were collected preoperatively, the platelet gelsolin concentrations were detected, and the blood stasis syndrome scores in patients were evaluated. The patients were followed up for 6 months, and the occurrence of major cardiovascular events(MACE) was recorded. To investigate the correlation between platelet gelsolin level, blood stasis syndrome score and clinical prognosis of patients with different subgroups of ACS. Results(1) Multivariate Logistic regression analysis revealed that the platelet gelsolin level and blood stasis syndrome score were the risk factors of the occurrence of MACE within 6 months in ACS patients.(2) When the platelet gelsolin level of 282.75, 253.20 and 324.30 μg/mL were selected as the optimal threshold.(3) When the blood stasis syndrome score of 30, 26 and 35 were selected as the optimal threshold.(4) The AUC of the platelet gelsolin level combined with blood stasis syndrome score in predicting the ACS prognosis was 0.901(95%CI: 0.854-0.949, P<0.01),suggesting that the combination of the two indexes displayed a higher predicting value for ACS prognosis. Conclusions It is speculated that, the platelet gelsolin level and blood stasis syndrome score are positively correlated with the prognosis for ACS. In addition, the combination of platelet gelsolin level with TCM blood stasis syndrome score shows a higher predicting value for ACS prognosis.
引文
[1] 卫生部心血管病防治研究中心.中国心血管病报告 2017[M].北京:中国大百科全书出版社,2018:1-3.
[2] 刘玥,蒋跃绒,殷惠军,等.凝溶胶蛋白与心血管疾病[J].中国分子心脏病学杂志,2011,11(1):50-53.
[3] Huang F,Yao M,Li F,et al.Reduction of plasma gelsolin levels correlates with development of multiple organ dysfunction syndrome and fatal outcome in burn patients[J].PLoS One,2011,6(11):e25748.
[4] Jin Y,Li BY,Qiu LL,et al.Decreased plasma gelsolin is associated with 1-year outcome in patients with traumatic brain injury[J].J Crit Care,2012,27(5):527.e1-527.e6.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[6] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[7] 中国中西医结合学会活血化瘀专业委员会.冠心病血瘀证诊断标准[J].中国中西医结合杂志,2016,36(10):1162.
[8] Liu Y,Yin HJ,Jiang YR,et al.Correlation between platelet gelsolin levels and different types of coronary heart disease[J].Chinese Science Bulletin,2012,57(6):631-638.
[9] 陈云宪,唐良秋,陈兆基,等.血浆凝溶胶蛋白在急性ST段抬高型心肌梗死患者中的水平及意义[J].中国心血管杂志,2016,21(5):375-379.
[10] 梁家荣,唐良秋,陈云宪,等.血浆凝溶胶蛋白在急性ST段抬高心肌梗死患者中的表达及意义[J].中国介入心脏病学杂志,2016,24(9):506-510.
[11] 李雪峰,蒋跃绒,吴彩凤,等.冠心病血小板功能蛋白与证侯相关性研究[J].中国分子心脏病学杂志,2009,9(6):326-331.
[12] Liu Y,Yin HJ,Chen KJ.Research on the correlation between platelet gelsolin and blood-stasis syndrome of coronary heart disease[J].Chin J Integr Med,2011,17(8):587-592.
[13] 徐峥,张并璇,宋庆桥,等.真实世界下不同中医证候要素慢性心力衰竭患者远期预后的比较分析[J].北京中医药大学学报,2015,38(9):635-640.
[14] 徐良,张伟骏,陶水良,等.基于中医证候要素的重症急性脑血管病的预后相关性研究[J].中国中医急症,2014,23(10):1860-1862.
[15] 谷丰.急性冠脉综合征患者介入治疗后中医证候要素与预后的相关性研究[D].北京:中国中医科学院,2011.
[16] 郗瑞席,陈可冀,史大卓,等.介入术后冠心病中医证候诊断标准的评价[J].中国中西医结合杂志,2013,33(8):1036-1041.
[2] 刘玥,蒋跃绒,殷惠军,等.凝溶胶蛋白与心血管疾病[J].中国分子心脏病学杂志,2011,11(1):50-53.
[3] Huang F,Yao M,Li F,et al.Reduction of plasma gelsolin levels correlates with development of multiple organ dysfunction syndrome and fatal outcome in burn patients[J].PLoS One,2011,6(11):e25748.
[4] Jin Y,Li BY,Qiu LL,et al.Decreased plasma gelsolin is associated with 1-year outcome in patients with traumatic brain injury[J].J Crit Care,2012,27(5):527.e1-527.e6.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007,35(4):295-304.
[6] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[7] 中国中西医结合学会活血化瘀专业委员会.冠心病血瘀证诊断标准[J].中国中西医结合杂志,2016,36(10):1162.
[8] Liu Y,Yin HJ,Jiang YR,et al.Correlation between platelet gelsolin levels and different types of coronary heart disease[J].Chinese Science Bulletin,2012,57(6):631-638.
[9] 陈云宪,唐良秋,陈兆基,等.血浆凝溶胶蛋白在急性ST段抬高型心肌梗死患者中的水平及意义[J].中国心血管杂志,2016,21(5):375-379.
[10] 梁家荣,唐良秋,陈云宪,等.血浆凝溶胶蛋白在急性ST段抬高心肌梗死患者中的表达及意义[J].中国介入心脏病学杂志,2016,24(9):506-510.
[11] 李雪峰,蒋跃绒,吴彩凤,等.冠心病血小板功能蛋白与证侯相关性研究[J].中国分子心脏病学杂志,2009,9(6):326-331.
[12] Liu Y,Yin HJ,Chen KJ.Research on the correlation between platelet gelsolin and blood-stasis syndrome of coronary heart disease[J].Chin J Integr Med,2011,17(8):587-592.
[13] 徐峥,张并璇,宋庆桥,等.真实世界下不同中医证候要素慢性心力衰竭患者远期预后的比较分析[J].北京中医药大学学报,2015,38(9):635-640.
[14] 徐良,张伟骏,陶水良,等.基于中医证候要素的重症急性脑血管病的预后相关性研究[J].中国中医急症,2014,23(10):1860-1862.
[15] 谷丰.急性冠脉综合征患者介入治疗后中医证候要素与预后的相关性研究[D].北京:中国中医科学院,2011.
[16] 郗瑞席,陈可冀,史大卓,等.介入术后冠心病中医证候诊断标准的评价[J].中国中西医结合杂志,2013,33(8):1036-1041.
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