不同类型冠心病患者血浆可溶性CD146水平的检测及其临床意义

Detection and clinical significance of soluble CD146 in plasma of patients with different types of coronary heart disease

摘要:

目的 通过观察不同类型冠心病患者血浆中可溶性CD146（sCD146）水平的差异，探讨其对冠心病的预测价值。方法 选取2018年11月—2019年2月新乡医学院第一附属医院心内科住院患者81例，根据临床表现及冠状动脉造影结果分为急性心肌梗死组、不稳定型心绞痛组及稳定型心绞痛组，冠状动脉造影未见明显异常的为正常组。收集各组患者的临床资料，酶联免疫吸附试验（ELISA）检测各组sCD146水平，根据冠状动脉造影结果计算Gensini评分，对各组的临床资料进行统计分析，采用多因素Logistic回归分析影响急性冠脉综合征的危险因素，Spearman法分析冠心病组sCD146水平与Gensini评分的相关性，绘制受试者工作特征（ROC）曲线预测不同类型冠心病。结果 白细胞计数［O^R=2.512（95% CI：1.210，5.214）］、肌酸激酶同工酶［O^R=2.119（95% CI：1.059，4.240）］、丙氨酸氨基转移酶［O^R=1.963（95% CI：1.222，3.153）］、天门冬氨酸氨基转移酶［O^R=2.219（95% CI：1.095，4.497）］、血肌酐［O^R=1.202（95% CI：1.016，1.421）］、左室舒张末期内径［O^R=1.802（95% CI：1.221，3.847）］、左室射血分数［O^R=2.203（95% CI：1.262，3.847）］及sCD146水平［O^R=2.118（95% CI：1.114，4.027）］的升高是急性冠脉综合征发生的危险因素（P <0.05）。冠心病组sCD146水平与正常对照组比较，差异有统计学意义（P <0.05），Spearman相关性分析结果显示，冠心病组sCD146水平和Gensini评分之间呈正相关（r_s =0.778，P =0.000）。ROC曲线结果显示，血浆sCD146水平为187.4 ng/mL时预测急性心肌梗死的敏感性和特异性最佳，分别为87.02%（95% CI：0.785，0.944）和88.2%（95% CI：0.795，0.967），约登指数为0.752；血浆sCD146水平为170.3 ng/mL时预测不稳定型心绞痛的敏感性和特异性最佳，分别为96.01%（95% CI：0.832，0.996）和76.48%（95% CI：0.501，0.935），约登指数为0.725；血浆sCD146水平为147.43 ng/mL时预测稳定型心绞痛的敏感性和特异性最佳，分别为62.5%（95% CI：0.354，0.848）和76.47%（95% CI：0.501，0.932），约登指数为0.390。结论 sCD146水平可能反映冠心病的发生发展，为预判冠心病病情提供新思路。

Abstract:

Objective To observe the difference of plasma soluble CD146 levels in patients with different types of coronary heart disease, and to explore the predictive value for coronary heart disease.Methods From November 2018 to February 2019, 81 inpatients in the second ward of cardiovascular department of the First Affiliated Hospital of Xinxiang Medical College were collected. According to the clinical manifestations and the results of coronary angiography, they were divided into acute myocardial infarction group, unstable angina group and stable angina group. Those without obvious abnormality in coronary angiography were normal control group. The clinical data of the patients in each group were collected, the level of sCD146 in each group was detected by ELISA, and the Gensini score was calculated according to the results of coronary angiography. The correlation between sCD146 level and Gensini score in the coronary heart disease group was analyzed, and the ROC curve for predicting different types of coronary heart disease was established.Results WBC [ O^R = 2.512 (95% CI: 1.210, 5.214) ], CK-MB [ O^R = 2.119 (95% CI: 1.059, 4.240) ], ALT [ O^R = 1.963 (95% CI: 1.222, 3.153) ], AST [ O^R = 2.219, (95% CI: 1.095, 4.497) ], Cr [ O^R = 1.202 (95% CI: 1.016, 1.421) ], LVDd [ O^R = 1.802 (95% CI: 1.221, 3.847) ], LVEF [ O^R = 2.203 (95% CI: 1.262, 3.847) ], and the level of sCD146 [ O^R = 2.118 (95% CI: 1.114, 4.027) ] were the risk factors of ACS (P < 0.05). The level of sCD146 in coronary heart disease group was significantly different from that in normal control group (P < 0.05), and Spearman correlation analysis showed that there was a positive correlation between the level of sCD146 and Gensini score in the coronary heart disease group (r_s = 0.778, P = 0.000). With establishing ROC curve, when the level of plasma sCD146 was 187.4 ng/mL, the sensitivity and specificity of predicting acute myocardial infarction were the best [87.02% (95% CI: 0.785, 0.944）and 88.2% (95% CI: 0.795, 0.967) ], and the Yoden index was 0.752; when the level of plasma sCD146 was 170.3 ng/mL, the sensitivity and specificity of predicting unstable angina were the best [96.01% (95% CI: 0.832, 0.996) and 76.48% (95% CI: 0.501, 0.935) ], and the Yoden index was 0.725; When the level of scd146 was 147.43 ng/mL, the sensitivity and specificity of sCD146 were 62.5% (95% CI: 0.354, 0.848) and 76.47% (95% CI: 0.501, 0.932), and the Yoden index was 0.390.Conclusions The level of sCD146 may reflect the occurrence and development of coronary heart disease, and provide a new way to predict the condition of coronary heart disease.