急性ST段抬高型心肌梗死患者急性期冠状动脉病变评分与血清胱抑素C水平的相关性
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摘要
目的探讨急性ST段抬高型心肌梗死(STEMI)急性期冠状动脉病变评分与血清胱抑素C(CysC)水平的相关性。方法选取2016年9月～2018年4月在浙江省湖州市第一人民医院就诊的384例STEMI患者作为研究对象,记录患者的CysC水平,患者的冠状动脉病变评分采用冠状动脉狭窄程度(Gensini)评分,观察患者CysC水平与Gensini评分的相关性。结果随着病变程度增加,CysC水平逐渐降低,组间比较差异均有高度统计学意义(P <0.01)。Pearson相关分析结果显示,性别、居住地、饮酒与STEMI患者Gensini评分无相关性(P> 0.05);发病至介入时间、年龄、糖尿病、高血压、高脂血症、吸烟、冠心病家族史、体重指数、血糖、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、收缩压、舒张压、肌酸激酶同工酶(CK-MB)、脑钠肽(NT-proBNP)、超敏C反应蛋白(hs-CRP)与STEMI患者Gensini评分呈正相关(P <0.05),CysC、高密度脂蛋白胆固醇(HDL-C)、左室射血分数(LVEF)与Gensini评分呈负相关(P <0.05)。以Gensini评分为因变量,其他因素为自变量进行多变量Logistic回归分析,结果显示,LDL-C、CysC、hs-CRP是影响Gensini评分的独立危险因素(P <0.05)。结论 STEMI患者急性期CysC水平与Gensini水平呈负相关,有助于临床评估STEMI的病情严重程度。
Objective To investigate the correlation between coronary artery lesion score and serum cystatin C(CysC)level in acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 384 STEMI patients admitted to Huzhou First People′s Hospital of Zhejiang Provmce from September 2016 to April 2018 were selected. The CysC level was recorded. Patients were assessed for coronary artery disease by coronary artery stenosis score(Gensini). The correlation between CysC level and Gensini score was observed. Results The CysC levels gradually decreased with the increase of lesion severity, and there was remarkably statistically significant difference among the groups(P < 0.01).The Pearson correlation analysis showed that gender, residence, alcohol consumption were not correlated with the Gensini score of STEMI patients(P > 0.05), and the gensini score was positively correlated with onset to intervening time, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary heart disease, body mass index,blood glucose, total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), systolic blood pressure, diastolic blood pressure, creatine kinase isoenzyme(CK-MB), brain natriuretic peptide(NT-proBNP), hypersensitive c-reactive protein(hs-CRP)(P < 0.05), while the CysC, high density lipoprotein cholesterol(HDL-C), left ventricular ejection fraction(LVEF) were negatively correlated with Gensini score(P < 0.05). Gensini score was used as dependent variable, other factors as independent variables were analyzed in multiple regression analysis, and the results showed that LDL-C, CysC, hs-CRP were independent risk factors affecting Gensini evaluation(P < 0.05). Conclusion The CysC level in acute STEMI patients are negatively correlated with Gensini levels, which is helpful to assess the severity of STEMI.
Objective To investigate the correlation between coronary artery lesion score and serum cystatin C(CysC)level in acute ST-segment elevation myocardial infarction(STEMI). Methods A total of 384 STEMI patients admitted to Huzhou First People′s Hospital of Zhejiang Provmce from September 2016 to April 2018 were selected. The CysC level was recorded. Patients were assessed for coronary artery disease by coronary artery stenosis score(Gensini). The correlation between CysC level and Gensini score was observed. Results The CysC levels gradually decreased with the increase of lesion severity, and there was remarkably statistically significant difference among the groups(P < 0.01).The Pearson correlation analysis showed that gender, residence, alcohol consumption were not correlated with the Gensini score of STEMI patients(P > 0.05), and the gensini score was positively correlated with onset to intervening time, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary heart disease, body mass index,blood glucose, total cholesterol(TC), triglyceride(TG), low density lipoprotein cholesterol(LDL-C), systolic blood pressure, diastolic blood pressure, creatine kinase isoenzyme(CK-MB), brain natriuretic peptide(NT-proBNP), hypersensitive c-reactive protein(hs-CRP)(P < 0.05), while the CysC, high density lipoprotein cholesterol(HDL-C), left ventricular ejection fraction(LVEF) were negatively correlated with Gensini score(P < 0.05). Gensini score was used as dependent variable, other factors as independent variables were analyzed in multiple regression analysis, and the results showed that LDL-C, CysC, hs-CRP were independent risk factors affecting Gensini evaluation(P < 0.05). Conclusion The CysC level in acute STEMI patients are negatively correlated with Gensini levels, which is helpful to assess the severity of STEMI.
引文
[1]周辉,王岚峰.脂蛋白(a)与急性ST段提高型心肌梗死患者冠脉病变严重程度相关性研究[J].现代中西医结合杂志,2016,25(25):2761-2764.
[2]刘锦全.急性心肌梗死治疗期间血压变异性、血尿酸的变化及其与冠脉Gensini积分的关系[J].热带医学杂志,2016,16(10):1316-1319.
[3]景蓉蓉,崔明,丛辉,等.凝血指标检测与急性冠脉综合征患者Gensini及Grace评分的关系研究[J].中国实验诊断学,2014,18(12):1940-1943.
[4]杨燕.缺血修饰蛋白、Cys C联合检测在急性心肌梗死早期诊断中的价值[J].国际检验医学杂志,2017,38(10):1421-1422.
[5]焦云娣,于彤彤,李志超,等.Cys C对经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者预后的预测价值[J].中国药物与临床,2018,18(1):98-100.
[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与治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[7]于会宁,张迎怡,丛洪良.冠心病患者糖耐量减低与冠状动脉Gensini评分的关系[J].临床心血管病杂志,2010,26(1):30-32.
[8]张琼,黄建华,熊三军,等.老年男性冠心病患者抑郁评分、血清性激素水平与冠脉Gensini评分的相关性[J].中华行为医学与脑科学杂志,2015,24(7):611-614.
[9]赵春勇,魏广林,高筱红,等.替罗非班、阿司匹林和氯吡格雷三联抗血小板治疗对急性心肌梗死患者急诊经皮冠状动脉介入治疗后主要心脏不良事件发生率的影响[J].中国生化药物杂志,2017,37(4):382-384.
[10]韩玉龙,梁立龙,许明生,等.血清同型半胱氨酸水平对急性冠脉综合征患者影响及其与冠状动脉病变支数、冠状动脉病变严重程度的相关性研究[J].实用心脑肺血管病杂志,2016,24(11):20-24.
[11]周齐艳,周娟,蒋恒波.血清对氧磷酶1在评估急性冠脉综合征患者冠脉病变程度中的临床价值[J].中国现代医学杂志,2015,25(34):56-59.
[12]艾民,颜昌福,夏福纯,等.血清hs-CRP及VEGF水平对急性心肌梗死经皮冠状动脉介入治疗术后心血管事件的影响[J].山东医药,2018,58(1):16-18.
[13]王婷,李结华.hs-CRP、BNP和cTn I联合检测对急性心肌梗死患者PCI术后MACE的预测价值[J].重庆医学,2017,46(3):380-382.
[14]冯玉平,郑子龙,钟丽华,等.心脉隆注射液对冠心病心衰患者血清hsCRP、BNP及LDL-C的影响[J].中西医结合心脑血管病杂志,2015,13(9):1089-1090.
[15]Jeong HC,Ahn Y,Park KH,et al.Effect of statin treatment in patients with acute myocardial infarction and left ventricular systolic dysfunction according to the level of high-sensitivity C-reactive protein[J].Int Heart J,2014,55(2):106-112.
[16]游志刚,黄琳,姜醒华.联合检测CRP、BNP和cTnI在急性心肌梗死患者中的临床意义[J].热带医学杂志,2015,15(1):56-58.
[17]宋艳,王亚萍,索萌,等.急性冠脉综合征肥胖及非肥胖患者血清LDL-C/HDL-C比值与冠状动脉病变严重程度的相关性[J].西安交通大学学报:医学版,2013,34(1):54-57,72.
[18]黄凤敏,彭琪,韩劼,等.急性心肌梗死患者PCI术后LDL-C水平与心血管事件的关系分析[J].标记免疫分析与临床,2018,25(2):245-249.
[19]张爱爱,谭俊晖,易梦阳,等.急性冠状动脉综合征患者OX-LDL、ADAMTS-1及hs-CRP的观察[J].心脑血管病防治,2017,17(5):338-340,352.
[20]刘丽霞,宗文仓.急性心肌梗死患者血清CysC水平浓度的变化[J].心脑血管病防治,2015,15(1):29-30,77.
[21]Angelidis C,Deftereos S,Giannopulos G,et al.Cystatin C:an emerging biomarker in cardiovascular disease[J]Curr Top Med Chem,2013,13(2):164-179.
[22]郭莉青,王瑞英,张玲,等.CysC与非ST段抬高型急性冠脉综合征患者冠脉病变及预后的相关性[J].山西医科大学学报,2016,47(12):1094-1097.
[23]Luc G,Bard JM,Lesueur C,et al.Plasma cystatin-C and development of coronary heart disease:The PRIME study[J].Atherosclerosis,2006,85:375-380.
[24]Ix JH,Shlipak MG,Chertow GM,et al.Association of cystatin C with mortality,cardiovascular evetns,and incident heart failure among persons with coronary heart disease:data from the Heart and Soul study[J].Circulation,2007,115(2):173-179.
[25]刘玉,刘俊,陶春明,等.CysC与急性冠脉综合征的相关性分析[J].中华全科医学,2012,10(2):208-244.
[26]董巧玲,刘俊.血清半胱氨酸蛋白酶抑制剂C在急性心肌梗死患者发病不同时期浓度的变化[J].中国循环杂志,2007,22(1):34.
[2]刘锦全.急性心肌梗死治疗期间血压变异性、血尿酸的变化及其与冠脉Gensini积分的关系[J].热带医学杂志,2016,16(10):1316-1319.
[3]景蓉蓉,崔明,丛辉,等.凝血指标检测与急性冠脉综合征患者Gensini及Grace评分的关系研究[J].中国实验诊断学,2014,18(12):1940-1943.
[4]杨燕.缺血修饰蛋白、Cys C联合检测在急性心肌梗死早期诊断中的价值[J].国际检验医学杂志,2017,38(10):1421-1422.
[5]焦云娣,于彤彤,李志超,等.Cys C对经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者预后的预测价值[J].中国药物与临床,2018,18(1):98-100.
[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与治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[7]于会宁,张迎怡,丛洪良.冠心病患者糖耐量减低与冠状动脉Gensini评分的关系[J].临床心血管病杂志,2010,26(1):30-32.
[8]张琼,黄建华,熊三军,等.老年男性冠心病患者抑郁评分、血清性激素水平与冠脉Gensini评分的相关性[J].中华行为医学与脑科学杂志,2015,24(7):611-614.
[9]赵春勇,魏广林,高筱红,等.替罗非班、阿司匹林和氯吡格雷三联抗血小板治疗对急性心肌梗死患者急诊经皮冠状动脉介入治疗后主要心脏不良事件发生率的影响[J].中国生化药物杂志,2017,37(4):382-384.
[10]韩玉龙,梁立龙,许明生,等.血清同型半胱氨酸水平对急性冠脉综合征患者影响及其与冠状动脉病变支数、冠状动脉病变严重程度的相关性研究[J].实用心脑肺血管病杂志,2016,24(11):20-24.
[11]周齐艳,周娟,蒋恒波.血清对氧磷酶1在评估急性冠脉综合征患者冠脉病变程度中的临床价值[J].中国现代医学杂志,2015,25(34):56-59.
[12]艾民,颜昌福,夏福纯,等.血清hs-CRP及VEGF水平对急性心肌梗死经皮冠状动脉介入治疗术后心血管事件的影响[J].山东医药,2018,58(1):16-18.
[13]王婷,李结华.hs-CRP、BNP和cTn I联合检测对急性心肌梗死患者PCI术后MACE的预测价值[J].重庆医学,2017,46(3):380-382.
[14]冯玉平,郑子龙,钟丽华,等.心脉隆注射液对冠心病心衰患者血清hsCRP、BNP及LDL-C的影响[J].中西医结合心脑血管病杂志,2015,13(9):1089-1090.
[15]Jeong HC,Ahn Y,Park KH,et al.Effect of statin treatment in patients with acute myocardial infarction and left ventricular systolic dysfunction according to the level of high-sensitivity C-reactive protein[J].Int Heart J,2014,55(2):106-112.
[16]游志刚,黄琳,姜醒华.联合检测CRP、BNP和cTnI在急性心肌梗死患者中的临床意义[J].热带医学杂志,2015,15(1):56-58.
[17]宋艳,王亚萍,索萌,等.急性冠脉综合征肥胖及非肥胖患者血清LDL-C/HDL-C比值与冠状动脉病变严重程度的相关性[J].西安交通大学学报:医学版,2013,34(1):54-57,72.
[18]黄凤敏,彭琪,韩劼,等.急性心肌梗死患者PCI术后LDL-C水平与心血管事件的关系分析[J].标记免疫分析与临床,2018,25(2):245-249.
[19]张爱爱,谭俊晖,易梦阳,等.急性冠状动脉综合征患者OX-LDL、ADAMTS-1及hs-CRP的观察[J].心脑血管病防治,2017,17(5):338-340,352.
[20]刘丽霞,宗文仓.急性心肌梗死患者血清CysC水平浓度的变化[J].心脑血管病防治,2015,15(1):29-30,77.
[21]Angelidis C,Deftereos S,Giannopulos G,et al.Cystatin C:an emerging biomarker in cardiovascular disease[J]Curr Top Med Chem,2013,13(2):164-179.
[22]郭莉青,王瑞英,张玲,等.CysC与非ST段抬高型急性冠脉综合征患者冠脉病变及预后的相关性[J].山西医科大学学报,2016,47(12):1094-1097.
[23]Luc G,Bard JM,Lesueur C,et al.Plasma cystatin-C and development of coronary heart disease:The PRIME study[J].Atherosclerosis,2006,85:375-380.
[24]Ix JH,Shlipak MG,Chertow GM,et al.Association of cystatin C with mortality,cardiovascular evetns,and incident heart failure among persons with coronary heart disease:data from the Heart and Soul study[J].Circulation,2007,115(2):173-179.
[25]刘玉,刘俊,陶春明,等.CysC与急性冠脉综合征的相关性分析[J].中华全科医学,2012,10(2):208-244.
[26]董巧玲,刘俊.血清半胱氨酸蛋白酶抑制剂C在急性心肌梗死患者发病不同时期浓度的变化[J].中国循环杂志,2007,22(1):34.