Expression and significance of serum hs-cTnT, PCT, FIB and platelet aggregation rate in coronary heart disease
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摘要: 目的 探究高敏心肌肌钙蛋白T(hs-cTcT)、降钙素原(PCT)、纤维蛋白原(FIB)、血小板聚集率在冠心病中的表达及意义。方法 选取2019年9月—2022年11月收治的冠心病患者101例为观察组，另匹配同时段来院体检的健康人群32例为对照组。比较2组受试者血清hs-cTnT、PCT、FIB与血小板聚集率差异。按照冠状动脉造影结果计算Gensini评分，将观察组患者分为轻症组(61例，Gensini评分 < 40分)、重症组(40例，Gensini评分≥40分)。比较2组患者血清hs-cTnT、PCT、FIB与血小板聚集率差异，通过二元logistic回归模型、受试者工作曲线(ROC)分析hs-cTnT、PCT、FIB、血小板聚集率单独、联合检测对冠心病患者冠状动脉病变严重程度的预测价值。结果 与对照组比较，观察组患者hs-cTnT、PCT、FIB水平与血小板聚集率更高，差异有统计学意义(P < 0.05)。与轻症组比较，重症组患者hs-cTnT、PCT、FIB水平与血小板聚集率更高，差异有统计学意义(P < 0.05)。二元logistic回归分析显示血清hs-cTnT、PCT、FIB与血小板聚集率是影响冠心病患者冠状动脉病变严重程度的因素(P < 0.05)。ROC分析结果显示，血清hs-cTnT、PCT、FIB与血小板聚集率单独、联合预测曲线下面积分别为0.839、0.791、0.824、0.943、0.950，敏感度分别为0.925、0.875、0.975、0.900、0.950，特异度分别为0.623、0.672、0.803、0.902、0.869。结论 冠心病患者血清hs-cTnT、PCT、FIB与血小板聚集率均存在异常表达，hs-cTnT、PCT、FIB与血小板聚集率与冠心病患者冠状动脉病变严重程度有紧密联系，可为临床鉴别冠状动脉病变严重程度提供一定参考价值。Abstract: Objective To explore the expression and significance of high-sensitivity cardiac troponin T(hs-cTcT), procalcitonin(PCT), fibrinogen(FIB) and platelet aggregation rate in coronary heart disease.Methods 101 patients with coronary heart disease who were admitted to our hospital from September 2019 to November 2022 were selected as the observation group, and 32 patients who came to our hospital for physical examination at the same time were matched as the control group. The difference of serum hs-cTnT, PCT, FIB and platelet aggregation rate between the two groups were compared. According to the Gensini score, the patients in the observation group were divided into mild group(61 cases, Gensini score < 40 points) and severe group(40 cases, Gensini score≥40 points). The difference of serum hs-cTnT, PCT, FIB and platelet aggregation rate between the two groups were compared, and the predictive value of hs-cTnT, PCT, FIB and platelet aggregation rate alone and jointly on the severity of coronary artery disease in patients with coronary heart disease were analyzed through binary logistic regression model and subject working curve(ROC).Results Compared with the control group, the levels of hs-cTnT, PCT, FIB and platelet aggregation rate in the observation group were significantly higher(P < 0.05). Compared with the mild group, the levels of hs-cTnT, PCT, FIB and platelet aggregation rate in the severe group were significantly higher(P < 0.05). Binary logistic regression analysis showed that serum hs-cTnT, PCT, FIB and platelet aggregation rate were the factors affecting the severity of coronary artery disease in patients with coronary heart disease(P < 0.05). The ROC analysis results showed that serum hs-cTnT, PCT, FIB and platelet aggregation rate separately and jointly predicted the off-line area of 0.839, 0.791, 0.824, 0.943 and 0.950, respectively, with sensitivity of 0.925, 0.875, 0.975, 0.900 and 0.950, and specificity of 0.623, 0.672, 0.803, 0.902 and 0.869.Conclusion There were abnormal expressions of serum hs-cTnT, PCT, FIB and platelet aggregation rate in the patients with coronary heart disease. hs-cTnT, PCT, FIB and platelet aggregation rate were closely related to the severity of coronary artery disease in patients with coronary heart disease, which could provide some reference value for clinical differentiation of the severity of coronary artery disease.
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表 1 不同严重程度冠心病患者一般资料比较
指标 轻症组(n=61) 重症组(n=40) χ2/t P 性别/例(%) 0.020 0.886 男 42(68.9) 27(67.5) 女 19(31.1) 13(32.5) 年龄/岁 55.64±8.00 55.08±7.41 0.357 0.722 高血压/例(%) 26(42.6) 17(42.5) < 0.001 0.990 糖尿病/例(%) 20(32.8) 13(32.5) 0.001 0.976 心肌梗死史/例(%) 7(11.5) 4(10.0) 0.054 0.816 饮酒史/例(%) 41(67.2) 28(70.0) 0.087 0.768 吸烟史/例(%) 30(49.2) 20(50.8) 0.006 0.936 白细胞计数/(×109/L) 6.41±0.82 6.43±0.80 -0.121 0.904 血小板计数/(×109/L) 201.46±45.48 203.12±43.54 -0.182 0.856 血红蛋白/(g/L) 136.41±10.45 135.72±1.07 0.415 0.679 白蛋白/(g/L) 34.56±5.41 33.71±6.01 0.739 0.462 血肌酐/(μmol/L) 67.14±16.54 69.57±18.32 -0.692 0.491 总胆固醇/(μmol/L) 4.30±1.14 4.31±1.10 -0.044 0.965 高密度脂蛋白胆固醇/(mmol/L) 1.19±0.27 1.17±0.30 0.348 0.728 低密度脂蛋白胆固醇/(mmol/L) 2.60±0.95 2.63±0.99 -0.153 0.879 
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表 2 2组血清hs-cTnT、PCT、FIB与血小板聚集率比较
X±S 组别 例数 hs-cTnT/(pg/L) PCT/(μg/mL) FIB/(g/L) 血小板聚集率/% 观察组 101 314.76±61.06 0.31±0.24 4.94±0.74 47.38±9.76 对照组 32 25.14±3.62 0.05±0.01 3.01±0.06 30.14±10.45 t 26.749 6.185 14.809 8.561 P < 0.001 < 0.001 < 0.001 < 0.001
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表 3 不同病情患者血清hs-cTnT、PCT、FIB与血小板聚集率比较 X±S
组别 例数 hs-cTnT/(pg/L) PCT/(μg/mL) FIB/(g/L) 血小板聚集率/% 轻症组 61 287.43±50.12 0.21±0.21 4.51±0.59 41.45±6.67 重症组 40 356.45±52.38 0.46±0.19 5.60±0.34 56.43±6.07 t -6.649 -6.060 -28.104 -11.433 P < 0.001 < 0.001 < 0.001 < 0.001
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表 4 影响冠心病患者冠状动脉病变严重程度的二元logistic回归分析
因素 β SE Wald P OR 95%CI hs-cTnT 0.028 0.006 21.865 < 0.001 1.028 1.016~1.040 PCT 5.580 1.202 21.541 < 0.001 265.045 25.117~2 796.926 FIB 3.517 0.635 30.658 < 0.001 33.672 9.697~116.919 血小板聚集率 0.337 0.064 28.123 < 0.001 1.401 1.237~1.587
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表 5 血清hs-cTnT、PCT、FIB与血小板聚集率单独、联合鉴别冠心病患者冠状动脉病变严重程度的ROC曲线分析
检验结果变量 AUC SE P 灵敏度 特异度 截断值 95%CI 下限值 上限值 hs-cTnT 0.839 0.041 < 0.001 0.925 0.623 0.548 pg/L 0.759 0.920 PCT 0.791 0.044 < 0.001 0.875 0.672 0.325 μg/mL 0.705 0.878 FIB 0.924 0.030 < 0.001 0.975 0.803 0.778 g/L 0.865 0.982 血小板聚集率 0.943 0.022 < 0.001 0.900 0.902 49.455% 0.900 0.986 联合 0.950 0.020 < 0.001 0.950 0.869 0.233 0.911 0.989
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[1] 王怡雯, 韩拓, 王丽霞, 等. 脂蛋白(a)与冠心病相关性的研究进展[J]. 临床心血管病杂志, 2022, 38(11): 860-863. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202211004.htm
[2] Dibben GO, Faulkner J, Oldridge N, et al. Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis[J]. Eur Heart J, 2023, 44(6): 452-469. doi: 10.1093/eurheartj/ehac747
[3] Stone PH, Libby P, Boden WE. Fundamental Pathobiology of Coronary Atherosclerosis and Clinical Implications for Chronic Ischemic Heart Disease Management-The Plaque Hypothesis: A Narrative Review[J]. JAMA Cardiol, 2023, 8(2): 192-201. doi: 10.1001/jamacardio.2022.3926
[4] Ramachandran HJ, Jiang Y, Tam WWS, et al. Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis[J]. Eur J Prev Cardiol, 2022, 29(7): 1017-1043. doi: 10.1093/eurjpc/zwab106
[5] Li J, Zheng L, Chan KHK, et al. Sex Hormone-Binding Globulin and Risk of Coronary Heart Disease in Men and Women[J]. Clin Chem, 2023, 69(4): 374-385. doi: 10.1093/clinchem/hvac209
[6] 冯惠平, 赵淑君, 张靖, 等. 和肽素联合高敏心肌肌钙蛋白I对心肌肌钙蛋白轻度增高的急性心肌梗死的早期诊断价值[J]. 中国医刊, 2022, 57(5): 502-504.
[7] 郑煜博, 杨伟, 闫淼佳, 等. 性别和年龄对高敏心肌肌钙蛋白T诊断急性心肌梗死截断值及效能的影响分析[J]. 中国医药, 2023, 18(9): 1286-1289. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202309002.htm
[8] 詹永忠, 程龙飞, 林旭城. 心内科冠心病合并肺部感染患者血清PCT、CRP、IL-6水平变化及临床意义[J]. 中国医药导报, 2022, 19(5): 68-70, 78. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202205041.htm
[9] 梁彦伟, 王颖, 原韶钟. 冠心病病人牙周状况与血清降钙素原及超敏C反应蛋白的相关性[J]. 中西医结合心脑血管病杂志, 2022, 20(9): 1714-1718.
[10] 丁云蕾, 赵银红, 何敏, 等. 冠心病患者D-二聚体/纤维蛋白原比值与心外膜脂肪层厚度的相关性分析[J]. 中国心血管病研究, 2023, 21(2): 149-154. https://www.cnki.com.cn/Article/CJFDTOTAL-XXGZ202302010.htm
[11] 王永进, 卫娇娜, 杜亚坤, 等. 血浆Hcy、D-D及Fib在2型糖尿病并发冠心病患者中的水平变化及相关性分析[J]. 检验医学与临床, 2022, 19(5): 691-694.
[12] 王源泉, 张晓静, 邹建华, 等. 硫酸氢氯吡格雷联合阿司匹林治疗老年冠心病对凝血指标、血小板聚集率的影响[J]. 中国医药科学, 2017, 7(6): 23-26.
[13] 张以昆, 韩景波, 王庆高, 龚国平, 刘鹏业. 化痰开痹汤对冠心病心绞痛痰浊痹阻型病人血栓前状态及血小板聚集率的影响[J]. 中西医结合心脑血管病杂志, 2022, 20(10): 1732-1735.
[14] 中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会动脉粥样硬化与冠心病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 等. 稳定性冠心病诊断与治疗指南[J]. 中华心血管病杂志, 2018, 46(9): 680-694. https://www.cnki.com.cn/Article/CJFDTOTAL-XXFZ201902001.htm
[15] 朱志鸿, 杨阳, 王云锋, 等. 中国华中地区冠心病和缺血性脑卒中二级预防抗血小板与他汀治疗现况调查[J]. 临床心血管病杂志, 2022, 38(2): 101-106. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202202005.htm
[16] Voutilainen A, Brester C, Kolehmainen M, et al. Epidemiological analysis of coronary heart disease and its main risk factors: are their associations multiplicative, additive, or interactive?[J]. Ann Med, 2022, 54(1): 1500-1510.
[17] Duggan JP, Peters AS, Trachiotis GD, et al. Epidemiology of coronary artery disease[J]. Surg Clin North Am, 2022, 102(3): 499-516.
[18] Smith TW. Intimate relationships and coronary heart disease: implications for risk, prevention, and patient management[J]. Curr Cardiol Rep, 2022, 24(6): 761-774.
[19] 刘全良, 吴连杰, 陈钊, 等. 冠心病患者小而密低密度脂蛋白水平与Gensini评分的相关性研究[J]. 标记免疫分析与临床, 2021, 28(4): 639-642.
[20] 马萍, 韩笑, 王广勇, 等. 老年冠心病合并糖尿病患者血清Apelin-13水平及与Gensini评分的关系[J]. 中国老年学杂志, 2022, 42(3): 516-519.
[21] 张倩, 杨毅. 心肌肌钙蛋白对慢性肾脏病患者冠心病的应用研究进展[J]. 临床内科杂志, 2022, 39(1): 61-63. https://www.cnki.com.cn/Article/CJFDTOTAL-LCLZ202201022.htm
[22] 伍慧妍, 沈昱民. 冠心病患者CRP、SAA、PCT、IL-6水平与冠状动脉粥样硬化的相关性研究[J]. 检验医学与临床, 2021, 18(9): 1250-1253.
[23] 申剑峰, 王海红. 参麦注射液联合长效硝酸异山梨酯对冠心病心绞痛患者疗效及对血小板聚集率的影响分析[J]. 贵州医药, 2022, 46(11): 1794-1796. https://www.cnki.com.cn/Article/CJFDTOTAL-GZYI202211067.htm
[24] 杨丽霞, 董丽, 郭海霞. 冠心病患者血清AnnexinⅡ、FIB、TM变化对冠脉病变程度及预后的影响[J]. 标记免疫分析与临床, 2022, 29(3): 418-421, 447. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY202203013.htm
[25] 姜姝, 孙淼淼, 宋魏. 参麦注射液联合长效硝酸异山梨酯对冠心病心绞痛患者血小板聚集率的影响[J]. 世界中医药, 2019, 14(8): 2092-2095, 2100.
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