非ST段抬高性急性冠脉综合征患者C反应蛋白、胱抑素C、载脂蛋白A、脂蛋白a与GRACE评分的相关研究
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江苏省科教兴卫工程医学重点人才基金(RC2011045);江苏省“333”工程人才培养基金(BRA2012095)


Relationships between blood C-reactive protein,cystatin C,apolipoprotein A,lipoprotein a and GRACE risk score in patients with non-ST segment elevation acute coronary syndrome
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    摘要:

    目的:探讨非ST段抬高型急性冠脉综合征(non ST segment elevation acute coronary syndrome,NSTE-ACS)患者血浆高敏C反应蛋白(high sensitivity C reactive protein,hs-CRP)-胱抑素(cystatin C,Cys C)-载脂蛋白A(apolipoprotein A,ApoA)-脂蛋白a[Lipoprotein a,Lp(a)]的水平与全球急性冠状动脉事件注册(the global registry of acute coronary events,GRACE)评分的关系-方法:符合标准的NSTE-ACS患者共155例,分为非ST 段抬高性心肌梗死(non ST segment elevation myocardial infarction,NSTE-AMI)组和不稳定性心绞痛(unstable angina,UA)组,入院后进行GRACE评分,同时第2天清晨空腹采集肘静脉血检测hs-CRP-CysC-ApoA-Lp(a),与87例非冠心病患者进行对照比较-结果:NSTE-ACS患者hs-CRP-CysC-Lp(a)-GRACE评分与对照组比较均显著升高,ApoA显著降低,差异有统计学意义(P < 0.05);随着GRACE危险程度增高,血清hs-CRP-CysC-Lp(a)水平出现显著升高,ApoA显著降低,差异有统计学意义(P < 0.05);相关性分析显示NSTE-ACS患者GRACE评分与hs-CRP-CysC-Lp(a)呈显著正相关关系(r = 0.424,P < 0.01;r = 0.549,P < 0.01;r = 0.134,P < 0.05);与ApoA呈显著负相关关系(r = -0.167,P < 0.01);多元线性回归分析,血清CysC-hs-CRP水平对GRACE评分影响最大-结论:血清hs-CRP-CysC-ApoA-Lp(a)水平与冠心病密切相关,可作为反映冠状动脉粥样硬化程度的较好指标;血清hs-CRP-CysC-ApoA-Lp(a)水平越高,GRACE评分越高,在NSTE-ACS患者中联合运用可能对早期危险分层-预后评估及诊疗方案的选择有重要临床参考价值-

    Abstract:

    Objective:To evaluate the relationships between serum high-sensitivity C-reactive protein(hs-CRP),cystatin(CysC),apolipoprotein A(ApoA),lipoprotein a[Lp(a)]and the global registry of acute coronary events(GRACE)scores in patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS). Methods:A total of 155 patients with NSTE-ACS who made a definite diagnosis were selected and divided into the non-ST segment elevation myocardial infarction(NSTE-AMI)group and the unstable angina pectoris(UA) group. After admission,GRACE score was calculated and serum levels of hs-CRP,CysC,ApoA and Lp (a) were examined. Eighty-seven patients without coronary heart disease severed as control group. Results:The levels of serum hs-CRP,CysC,Lp(a) and the GRACE risk scores in NSTE-ACS patients were significantly increased compared with the control group,while the level of serum ApoA was significantly decreased and the differences were statistically significant(P < 0.05). With the increase of GRACE risk level,the levels of serum hs-CRP,CysC and Lp (a) were significantly increased,ApoA were significantly decreased and the differences were statistically significant(P < 0.05). The correlation analysis showed that GRACE scores had a positive correlation with hs-CRP,CysC,Lp(a)(r = 0.424,P < 0.01;r = 0.549,P < 0.01;r =0.134,P < 0.05),and a negative correlation with ApoA(r = -0.167,P < 0.01) in NSTE-ACS patients. Furthermore,the multiple linear regression analysis showed that CysC and hs-CRP had the greatest influence on the GRACE score. Conclusion:The levels of serum hs-CRP,CysC,ApoA and Lp(a) are closely related to coronary heart disease,which may be used as good indicators of extent of coronary atherosclerosis. For the NSTE-ACS patients,higher levels of hs-CRP,CysC,ApoA and Lp (a) indicated a higher GRACE scores. Combination of these indexes may have the important clinical value on early risk stratification,evaluation of prognosis and treatment options.

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徐 慧,龚开政,张 昕,夏光伟,张振刚,李 伟.非ST段抬高性急性冠脉综合征患者C反应蛋白、胱抑素C、载脂蛋白A、脂蛋白a与GRACE评分的相关研究[J].南京医科大学学报(自然科学版),2014,(6):761-765

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  • 收稿日期:2013-12-02
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  • 在线发布日期: 2014-06-19
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