Predictive value of serum Adropin in patients with non-ST-segment elevation acute coronary syndrome on the severity of coronary artery disease and slow blood flow during percutaneous coronary intervention
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摘要: 目的 研究非ST段抬高型急性冠脉综合征(NSTE-ACS)患者血清Adropin水平对冠脉病变程度和经皮冠状动脉介入治疗(PCI)中慢血流的预测价值。方法 选择2018年10月—2020年10月期间167例拟行PCI的NSTE-ACS患者作为研究对象，均行冠状动脉造影检查，使用电脑专用软件行Gensini冠脉评分，根据冠脉狭窄程度分为低危组(Gensini评分 < 30分)45例、中危组(30分≤Gensini评分≤90分)63例、高危组(评分>90分)59例，比较各组血清Adropin、超敏C反应蛋白(hs-CRP)、血脂指标、血肌酐(Scr)、肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)等指标的变化。支架置入后造影以校正的TIMI帧数计数(CTFC)评价左回旋支(LCX)、左前降支(LAD)和右冠状动脉(RCA)血流情况。采用Pearson法和受试者工作特征曲线(ROC)分析血清Adropin水平与Gensini评分、CTFC的相关性及预测价值。结果 各组Scr、CK-MB、cTnⅠ、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-L)、空腹血糖(FBG)水平比较均差异无统计学意义(P>0.05)。高危组血清Adropin水平低于中危组、低危组，但hs-CRP、三酰甘油(TG)水平高于中危组、低危组；中危组血清Adropin水平低于低危组，hs-CRP、TG水平高于低危组；均差异有统计学意义(P< 0.05)。PCI术中有31例出现慢血流，发生率为18.56%；其中高危组29例，发生率为49.15%；中危组2例，发生率为3.17%；低危组无慢血流发生。高危组LCX、LAD、RCA的CTFC、CTFC平均值及Gensini评分高于中危组、低危组，中危组LCX、LAD、RCA的CTFC、CTFC平均值及Gensini评分高于低危组，差异有统计学意义(P< 0.05)。血清Adropin与Gensini评分、CTFC呈负相关(r=-0.519、-0.326，P=0.014、0.039)。Adropin对Gensini评分和CTFC的ROC曲线下面积(AUC)分别为0.728、0.649；截断值分别为2.415 ng/L(95%CI0.626~0.804)、2.193 ng/L(95%CI0.592~0.805)；敏感度分别为75.69%、71.08%，特异度分别为92.71%、89.42%。结论 NSTE-ACS患者血清Adropin水平越低冠脉病变程度越严重，PCI术中发生慢血流的风险越高。
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关键词:
- 非ST段抬高急性冠脉综合征 /
- Adropin /
- 冠脉病变 /
- 经皮冠状动脉介入治疗 /
- 慢血流
Abstract: Objective To study the predictive value of serum Adropin level in patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS) on the degree of coronary artery disease and slow blood flow during percutaneous coronary intervention(PCI).Methods From October 2018 to October 2020, 167 NSTE-ACS patients who were planned to undergo percutaneous coronary intervention(PCI) were selected as the research subjects. All patients underwent coronary angiography and Gensini coronary artery was performed using computer-specific software According to the degree of coronary artery stenosis, they were divided into low-risk group(Gensini score < 30 points), 45 cases, intermediate-risk group(30 points ≤ Gensini score ≤ 90 points), 63 cases, high-risk group(score>90 points) 59 For example, compare the serum Adropin, high-sensitivity C-reactive protein(hs-CRP), blood lipids, serum creatinine(Scr), creatine kinase isoenzyme(CK-MB), troponin Ⅰ(cTnⅠ) and other indicators in each group variety. After stent placement, angiography was performed to evaluate the blood flow of the left circumflex branch(LCX), left anterior descending branch(LAD) and right coronary artery(RCA) with corrected TIMI frame count(CTFC). Pearson method and receiver operating curve(ROC) were used to analyze the correlation and predictive value of serum Adropin level with Gensini score and CTFC.Results There were no significant differences in the levels of Scr, CK-MB, cTnⅠ, TC, LDL-C, HDL-C, and FBG in each group(P>0.05). Serum Adropin levels in the high-risk group were lower than those in the intermediate-risk and low-risk groups. The hs-CRP and TG levels in the high-risk group were higher than those in the intermediate-risk and low-risk groups; the serum Adropin levels in the intermediate-risk group were lower than those in the low-risk group, hs-CRP and TG. The level was higher than the low-risk group; the differences were statistically significant(P< 0.05). Slow blood flow occurred in 31 cases during PCI, the incidence rate was 18.56%, of which 29 cases were in the high-risk group, the incidence rate was 49.15%, 2 cases in the medium-risk group, the incidence rate was 3.17%, and there was no slow blood flow in the low-risk group. The high-risk group LCX, LAD, RCA CTFC, CTFC average and Gensini score are higher than the intermediate-risk group, low-risk group, the intermediate-risk group LCX, LAD, RCA CTFC, CTFC average and Gensini score higher than the low-risk group, the difference There is statistical significance(P< 0.05). Serum Adropin was negatively correlated with Gensini score and CTFC(r=-0.519, -0.326;P=0.014, 0.039). The area under the ROC curve(AUC) of Adropin for Gensini score and CTFC were 0.728 and 0.649; the cut-off values were 2.415 ng/L(95%CI0.626-0.804) and 2.193 ng/L(95%CI0.592-0.805); the sensitivities were respectively They were 75.69% and 71.08%, and the specificities were 92.71% and 89.42%, respectively.Conclusion The lower the serum Adropin level in NSTE-ACS patients, the more severe the coronary artery disease, and the higher the risk of slow blood flow during PCI. -
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表 1 各组患者一般资料的比较
例，X±S 组别 例数 性别 病变血管数 危险因素 年龄/岁 BMI 男 女 单支 双支 多支 吸烟 高血压 糖尿病 高脂血症 低危组 45 25 20 27 13 5 11 13 6 8 62.19±12.52 26.43±3.95 中危组 63 36 27 19 23 21 25 27 11 15 61.83±11.97 26.87±4.28 高危组 59 36 23 3 32 24 31 32 13 26 63.05±12.84 27.33±4.46 χ2/F 1.437 29.371 15.836 1.162 0.729 P 0.081 < 0.001 < 0.001 0.095 0.375 
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表 2 各组Adropin水平及实验室相关指标比较
X±S 组别 例数 Adropin/ (ng·L-1) Scr/ (μmol·L-1) CK-MB/ (U·L-1) cTnⅠ/ (μg·L-1) hs-CRP/ (mmol·L-1) 低危组 45 3.21±0.42 86.39±12.57 41.27±6.37 15.36±1.36 18.26±2.81 中危组 63 2.82±0.381) 88.24±14.29 40.18±5.43 14.57±2.28 25.36±4.301) 高危组 59 2.38±0.311)2) 90.82±14.71 41.86±5.82 14.25±2.64 33.08±4.821)2) F 39.264 0.672 0.893 0.725 4.270 P < 0.001 0.427 0.209 0.374 0.036 与低危组比较，1)P < 0.05；与中危组比较，2)P < 0.05。
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表 3 各组血脂、血糖指标比较
mmol/L，X±S 组别 例数 TC TG LDL-C HDL-C FBG 低危组 45 5.08±0.76 1.61±0.26 2.86±0.42 1.18±0.19 5.43±0.82 中危组 63 4.96±0.59 1.88±0.351) 3.03±0.68 1.23±0.23 5.69±1.05 高危组 59 5.11±0.88 2.13±0.451)2) 2.75±0.81 1.19±0.17 5.93±1.17 F 0.392 5.019 0.419 0.538 0.497 P 0.701 0.023 0.682 0.562 0.607 与低危组比较，1)P < 0.05；与中危组比较，2)P < 0.05。
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表 4 各组LCX、LAD、RCA的CTFC及Gensini评分比较
X±S 组别 例数 CTFC Gensini评分/分 LCX LAD RCA 平均值 低危组 45 20.48±4.32 21.07±4.53 20.53±3.29 20.69±2.93 27.55±4.28 中危组 63 23.06±4.861) 23.94±4.961) 23.68±4.101) 23.56±3.551) 49.83±8.621) 高危组 59 25.63±5.171)2) 26.51±5.241)2) 25.41±4.691)2) 25.85±4.081)2) 71.08±12.851)2) F 9.253 10.284 9.842 9.350 21.072 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 与低危组比较，1)P < 0.05；与中危组比较，2)P < 0.05。
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表 5 Adropin、TG、hs-CRP水平与Gensini评分、CTFC的相关性
指标 Gensini评分 CTFC r P r P Adropin -0.519 0.014 -0.326 0.039 TG 0.173 0.041 0.028 0.084 hs-CRP 0.148 0.044 0.025 0.079
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表 6 Adropin水平对Gensini评分>60分和CTFC>27的预测价值
指标 AUC 截断值/(ng·L-1) 敏感度/% 特异度/% 95%CI Gensini评分>60分 0.728 2.415 75.69 92.71 0.626~0.804 CTFC>27 0.649 2.193 71.08 89.42 0.592~0.805
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