Evaluation value of serum homocysteine combined with coronary calcium score for short-term prognosis in patients with acute coronary syndrome
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摘要:目的
探讨血清同型半胱氨酸(Hcy)与冠状动脉钙化积分(CCS)联合检测对急性冠状动脉综合征(ACS)患者短期预后的评估价值。
方法选取180例住院冠心病患者为研究对象, 根据病情程度分为ACS组84例与慢性稳定型心绞痛(SAP)组96例。随访12个月, 根据ACS患者随访期间主要心血管不良事件(MACE)发生情况分为事件组36例和非事件组48例。比较2组患者CCS、血清Hcy、超敏C反应蛋白(hs-CRP)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平。分析ACS患者CCS与血清Hcy水平的相关性。分析随访12个月ACS患者MACE发生的危险因素。采用受试者工作特征(ROC)曲线评估CCS与血清Hcy水平预测随访12个月ACS患者预后的价值。
结果ACS组血清Hcy、hs-CRP、LDL-C、FPG、HbA1c水平高于SAP组, 而CCS低于SAP组, 差异有统计学意义(P < 0.05)。ACS患者CCS与血清Hcy水平呈负相关(P < 0.05)。事件亚组ACS患者的CCS低于非事件亚组, 血清Hcy水平高于非事件组, 差异有统计学意义(P < 0.05)。血清Hcy是随访12个月ACS患者发生MACE的危险因素(OR=2.872, P=0.020), CCS是保护性因素(OR=0.459, P=0.011)。ROC曲线显示, 血清Hcy截断值为21.5 μmol/L、CCS截断值为410.0分, 联合预测的曲线下面积(AUC)为0.822, 敏感度为86.3%, 特异度为80.6%。
结论CCS与血清Hcy水平联合检测评估ACS患者短期预后结局的准确度较好。
Abstract:ObjectiveTo explore the evaluation value of detection of serum homocysteine (Hcy) combined with coronary calcium score (CCS) for short-term prognosis in patients with acute coronary syndrome (ACS).
MethodsA total of 180 hospitalized patients with coronary heart disease were selected as research objects, and were divided into the ACS group (84 cases) and the stable angina pectoris (SAP)(96 cases) according to the severity of the disease.According to the incidence of major adverse cardiovascular events (MACE) during the follow-up period of 12 months, ACS patients were divided into event sub-group (n=36) and non-event sub-group (n=48).CCS, serum Hcy, high-sensitivity C-reactive protein (hs-CRP), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) of patients in two groups were compared.The correlation between CCS and serum Hcy level in ACS patients was analyzed.The main risk factors of MACE in ACS patients were analyzed after 12 months of follow-up.The value of CCS and serum Hcy level in predicting prognosis of ACS patients at 12 months follow-up was evaluated by receiver operating characteristic (ROC) curve.
ResultsThe serum levels of Hcy, hs-CRP, LDL-C, FPG and HbA1c in the ACS group were significantly higher than those in the SAP group, while the CCS was significantly lower than that in the SAP group (P < 0.05).CCS was negatively correlated with serum Hcy level in ACS patients (P < 0.05).The CCS of ACS patients in the event sub-group was significantly lower than that in the non-event sub-group, and the serum Hcy level was significantly higher than that in the non-event sub-group (P < 0.05).Serum Hcy was a risk factor for MACE in ACS patients followed up for 12 months (OR=2.872, P=0.020), and CCS was a protective factor (OR=0.459, P=0.011).The cut-off value of serum Hcy was 21.5 μmol/L, and the cut-off value of CCS was 410.0, the area under the curve (AUC) of joint prediction was 0.822, the sensitivity was 86.3%, and the specificity was 80.6%.
ConclusionThe combination of CCS and serum Hcy level has good accuracy in evaluating the short-term outcome of ACS patients.
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表 1 2组一般资料比较(x±s)[n(%)]
组别 年龄/岁 男 女 体质量指数/(kg/m2) 吸烟 饮酒 高血压病史 糖尿病史 ACS组(n=84) 60.3±8.5 49(58.3) 35(41.7) 26.6±2.4 26(31.0) 39(46.4) 49(58.3) 34(40.5) SAP组(n=96) 58.2±7.7 59(61.4) 37(38.6) 27.2±2.7 42(43.8) 56(58.3) 58(60.4) 47(49.0) ACS: 急性冠状动脉综合征; SAP: 慢性稳定型心绞痛。 
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表 2 2组临床指标水平比较(x±s)
组别 CCS/分 Hcy/(μmol/L) hs-CRP/(mg/L) LDL-C/(mmol/L) FPG/(mmol/L) HbA1c/% ACS组(n=84) 284.2±10.6* 20.5±3.6* 3.68±1.5* 3.95±0.5* 6.85±1.7* 6.1±0.5* SAP组(n=96) 427.1±21.3 13.7±2.2 2.35±1.2 3.67±0.4 6.23±1.1 5.3±0.4 ACS: 急性冠状动脉综合征; SAP: 慢性稳定型心绞痛; CCS: 冠状动脉钙化积分; Hcy: 同型半胱氨酸; hs-CRP: 超敏C反应蛋白: LDL-C: 低密度脂蛋白胆固醇; FPG: 空腹血糖; HbA1c: 糖化血红蛋白。与SAP组比较, * P < 0.05。
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表 3 事件组与非事件组临床指标水平比较(x±s)
组别 CCS/分 Hcy/(μmol/L) hs-CRP/(mg/L) LDL-C/(mmol/L) FPG/(mmol/L) HbA1c/% 事件组(n=36) 391.2±12.4* 22.3±3.9* 3.74±1.31 4.12±0.62 7.02±0.89 6.2±0.8 非事件组(n=48) 445.4±27.9 18.9±2.6 3.46±1.08 3.97±0.74 6.90±0.91 5.9±0.7 CCS: 冠状动脉钙化积分; Hcy: 同型半胱氨酸; hs-CRP: 超敏C反应蛋白: LDL-C: 低密度脂蛋白胆固醇; FPG: 空腹血糖; HbA1c: 糖化血红蛋白。与非事件组比较, * P>0.05。
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表 4 ACS组临床指标多元Logistic回归分析比较
指标 β S. E. Wald系数 OR P 95%CI 年龄 0.230 0.376 0.373 1.258 0.171 0.862~1.634 CCS -0.779 0.284 7.518 0.459 0.011 0.351~0.689 同型半胱氨酸 1.055 0.427 6.104 2.872 0.020 2.439~3.301 超敏C反应蛋白 0.700 0.405 2.984 2.013 0.058 0.821~3.125 低密度脂蛋白胆固醇 0.544 0.389 1.956 1.723 0.065 0.725~2.763 空腹血糖 0.509 0.416 1.498 1.664 0.077 9.824~2.272 糖化血红蛋白 0.197 0.203 0.944 1.218 0.085 0.736~1.753
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