血清ESM-1、sICAM-1与不稳定型心绞痛患者冠心病严重程度的关系及对急性心肌梗死发病的预测价值

Relationship between serum ESM-1 and sICAM-1 and the severity of coronary heart disease and their predictive values for acute myocardial infarction in patients with unstable angina pectoris

摘要:

目的 分析不稳定型心绞痛（UAP）患者血清内皮细胞特异分子-1（ESM-1）、可溶性细胞间黏附分子-1（sICAM-1）与冠状动脉粥样硬化性心脏病（以下简称冠心病）严重程度的关系及对急性心肌梗死（AMI）发病的预测价值。方法 选取2021年1月—2023年6月成都医学院第三附属医院收治的78例UAP患者。采用酶联免疫吸附试验检测ESM-1、sICAM-1水平。采用Gensini评估冠脉狭窄积分，依据患者狭窄积分将其分为轻中度组和重度组，分析不同病情严重程度患者ESM-1、sICAM-1水平。给予吸氧、抗血小板、抗凝、抗心肌缺血等治疗后，随访统计治疗6个月内AMI发生情况，将发生AMI患者纳入发生组，反之为未发生组。分析影响UAP患者发生AMI的因素及其对AMI发病的预测价值。结果 重度组ESM-1、sICAM-1水平均高于轻中度组（P <0.05）。发生组Gensini评分、ESM-1、sICAM-1、NYHA分级均高于未发生组（P <0.05），SAQ评分低于未发生组（P <0.05）。多因素逐步Logistic回归分析结果表明，Gensini评分［O^R=4.674（95% CI：1.598，13.675）］、SAQ评分［O^R=4.802（95% CI：1.641，14.049）］、ESM-1［O^R=5.573（95% CI：1.905，16.306）］和sICAM-1［O^R=4.411（95% CI：1.508，12.904）］是UAP患者发生AMI的危险因素（P <0.05）。受试者工作特征曲线结果表明，Gensini评分、ESM-1、sICAM-1、SAQ评分及联合预测UAP患者发生AMI的敏感性分别为70.0%（95% CI：0.570，0.830）、75.0%（95% CI：0.621，0.882）、75.0%（95% CI：0.614，0.872）、70.0%（95% CI：0.562，0.841）、90.0%（95% CI：0.862，0.904）；特异性分别为72.4%（95% CI：0.584，0.863）、75.7%（95% CI：0.618，0.898）、77.6%（95% CI：0.635，0.910）、67.0%（95% CI：0.548，0.823）、91.4%（95% CI：0.773，0.944）。Gensini评分、ESM-1、sICAM-1、SAQ评分联合预测UAP患者发生AMI的价值较高，曲线下面积> 0.9。结论 ESM-1、sICAM-1与冠心病严重程度有关，Gensini评分、ESM-1、sICAM-1、SAQ评分联合预测UAP患者发生AMI的效能较好。

Abstract:

Objective To analyze the relationship between serum endothelial cell specific molecule-1 (ESM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) and the severity of coronary heart disease and their predictive values for acute myocardial infarction (AMI) in patients with unstable angina pectoris (UAP).Methods The 78 UAP patients admitted to the Third Affiliated Hospital of Chengdu Medical College from January 2021 to June 2023 were selected. The levels of ESM-1 and sICAM-1 were detected by enzyme-linked immunosorbent assay. The Gensini score was used to assess coronary artery stenosis, and patients were divided into the mild to moderate group and the severe group based on their stenosis scores. The levels of ESM-1 and sICAM-1 were analyzed in patients with varying degrees of disease severity. Patients were given oxygen therapy, antiplatelet therapy, anticoagulant therapy, and treatments for myocardial ischemia. The incidence of AMI within 6 months of treatment was analyzed by follow-up. Patients developing AMI were included in the occurrence group, while those without AMI were included in the non-occurrence group. The factors affecting the occurrence of AMI in UAP patients and the predictive values of ESM-1 and sICAM-1 levels for AMI in UAP patients were analyzed.Results The levels of ESM-1 and sICAM-1 in the severe group were higher than those in the mild to moderate group (P < 0.05). Gensini scores, levels of ESM-1 and sICAM-1, and NYHA classifications in the occurrence group were higher than those in the non-occurrence group (P < 0.05), and SAQ scores in the occurrence group were lower than those in the non-occurrence group (P < 0.05). The multivariable Logistic regression analysis (inclusion of variables with P-value <0.05 and exclusion of variables with P-value > 0.10) showed that Gensini scores [O^R = 4.674 (95% CI: 1.598, 13.675) ], SAQ scores [O^R = 4.411 (95% CI: 1.641, 14.049) ], and levels of ESM-1 [O^R = 5.573 (95% CI: 1.905, 16.306) ] and sICAM-1 [O^R = 1.508 (95% CI: 1.508, 12.904) ] were factors affecting the occurrence of AMI in UAP patients (P < 0.05). The ROC curve analysis demonstrated that the sensitivities of Gensini scores, ESM-1 levels, sICAM-1 levels, SAQ scores and their combination for predicting AMI in UAP patients were 70.00% (95% CI: 0.570, 0.830), 75.0% (95% CI: 0.621, 0.882), 75.0% (95% CI: 0.614, 0.872), 70.0% (95% CI: 0.562, 0.841), and 90.0% (95% CI: 0.862, 0.904), with specificities being 72.4% (95% CI: 0.584, 0.863), 75.7% (95% CI: 0.618, 0.898), 77.6% (95% CI: 0.635, 0.910), 67.0% (95% CI: 0.548, 0.823), and 91.4% (95% CI: 0.773, 0.944). The combination of Gensini scores, ESM-1 levels, sICAM-1 levels and SAQ scores had a high value in predicting AMI occurrence in UAP patients (AUC > 0.9).Conclusions ESM-1 and sICAM-1 are correlated with the severity of coronary heart disease. The combination of Gensini scores, ESM-1 levels, sICAM-1 levels and SAQ scores is effective in predicting AMI in UAP patients.