血清胱抑素C水平与非阻塞性冠状动脉疾病的关系

doi:10.3969/j.issn.1004-583X.2023.09.005

摘要/Abstract

摘要：

目的探讨血清胱抑素C水平与非阻塞性冠状动脉(冠脉)疾病的关系。方法选取2021年6月-2021年12月在保定市第一中心医院心内科住院择期行冠脉造影的疑似老年冠心病患者331例,根据冠脉造影结果分为冠脉正常组和非阻塞性冠脉病变组,根据冠脉狭窄支数分为单支、双支、三支病变,计算Gensini积分。比较两组的一般临床资料和生化指标,并进行多因素Logistic回归分析。结果两组体质指数(BMI)、血小板、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、吸烟及冠心病家族史比较差异无统计学意义( $P$ >0.05);非阻塞性冠脉病变组年龄、性别构成、高血压率、糖尿病率、高血脂率、胱抑素C水平显著高于对照组( $P$ <0.05或<0.01)。在非阻塞性冠脉病变患者中胱抑素C水平升高者与胱抑素C水平正常者相比,其单支病变所占比例(28.1% vs 46.7%, $P$ <0.05)较低而三支病变所占比例(37.5% vs 20.0%, $P$ <0.05)较高。且随着胱抑素C水平的增高,Gensini积分也显著增高,二者呈正相关( $r$ =0.525, $P$ <0.01)。多因素Logistic回归分析结果显示,年龄、性别、高血脂、胱抑素C是非阻塞性冠脉病变的危险因素。结论血清胱抑素C水平可能是非阻塞性冠脉疾病的独立预测因子。

关键词: 非阻塞性冠状动脉疾病, 胱抑素C, 冠状动脉造影

Abstract:

Objective To investigate the correlation between serum cystatin C level and nonobstructive coronary artery disease. Methods A total of 331 elderly patients who underwent coronary angiography with suspected coronary artery disease in the Department of Cardiology, Baoding No.1 Central Hospital were enrolled between June 2021 and December 2021. They were divided into coronary normal group and nonobstructive coronary artery group according to the results of coronary angiography. Single-vessel, 2-vessel and 3-vessel lesions were classified according to the number of diseased coronary arteries and the Gensini score was calculated according to the results of coronary angiography. The general clinical data and biochemical indicators were compared between the two groups and multivariate Logistic regression analysis was used to identify the risk factors for nonobstructive coronary artery disease. Results There were no significant differences between the two groups in the body mass index (BMI), platelet count, fasting plasma glucose, low-density lipoprotein cholesterol (LDL-C), smoking and the family history of coronary artery disease ( $P$ >0.05). Age, sex constitution, proportion of hypertension, diabetes, and hyperlipidemia, and cystatin C levels were significantly higher in nonobstructive coronary artery group than those of coronary normal group ( $P$ <0.05 or <0.01). In nonobstructive coronary artery group, the proportion of single-vessel lesion was lower in patients with high cystatin C levels than those with low cystatin C levels (28.1% vs 46.7%, $P$ <0.05), but the proportion of 3-vessel lesion was significantly higher (37.5% vs 20.0%, $P$ <0.05). With the increase in cystatin C level, the Gensini score increased significantly, showing a positive correlation ( $r$ =0.525, $P$ <0.01). The multivariate Logistic regression analysis result showed that age, sex, hyperlipidemia, cystatin C were risk factors for nonobstructive coronary artery disease. Conclusion Cystatin C might serve as a significant prognostic marker for nonobstructive coronary artery disease.

Key words: nonobstructive coronary artery disease, cystatin C, coronary angiography

中图分类号:

R541.4

李华, 陈建军, 未纪涛, 张旗. 血清胱抑素C水平与非阻塞性冠状动脉疾病的关系[J]. 临床荟萃, 2023, 38(9): 802-805.

Li Hua, Chen Jianjun, Wei Jitao, Zhang Qi. Correlation between serum cystatin C level and nonobstructive coronary artery disease[J]. Clinical Focus, 2023, 38(9): 802-805.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.005

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/802

图/表 4

表1 两组一般资料的比较

Tab. 1 Comparison of general data between groups

项目	冠脉正常组( $n$ =207)	非阻塞性冠脉病变组( $n$ =124)	$t$ /χ²值	$P$ 值
年龄(岁, $bar{x} pm s$)	64.37±8.02	65.28±8.25	-3.212	0.034
男性[例(%)]	66(31.9)	57(46.0)	6.587	0.01
危险因素
BMI(kg/m², $bar{x} pm s$)	24.62±3.40	24.83±3.35	-0.536	0.592
吸烟[例(%)]	30(14.5)	26(21.0)	2.313	0.128
高血压[例(%)]	72(34.8)	64(51.6)	9.075	0.003
糖尿病[例(%)]	16(7.7)	21(16.9)	6.619	0.010
高血脂[例(%)]	19(9.2)	24(19.5)	7.270	0.007
冠心病家族史[例(%)]	9(4.3)	9(7.3)	1.277	0.258
血生化指标
血小板(×10⁹/L)	208.30±51.93	203.58±55.00	0.755	0.451
空腹血糖(mmol/L)	5.61±1.35	5.80±1.63	-1.018	0.309
TG(mmol/L)	1.89±0.82	2.02±0.88	-0.568	0.556
TC(mmol/L)	3.92±0.84	4.15±0.89	-0.604	0.435
LDL-C(mmol/L)	2.88±0.72	2.94±0.89	-0.610	0.542
胱抑素C(mg/L)	0.86±0.18	0.97±0.17	-5.507	<0.01

表1 两组一般资料的比较

Tab. 1 Comparison of general data between groups

项目	冠脉正常组( $n$ =207)	非阻塞性冠脉病变组( $n$ =124)	$t$ /χ²值	$P$ 值
年龄(岁, $bar{x} pm s$)	64.37±8.02	65.28±8.25	-3.212	0.034
男性[例(%)]	66(31.9)	57(46.0)	6.587	0.01
危险因素
BMI(kg/m², $bar{x} pm s$)	24.62±3.40	24.83±3.35	-0.536	0.592
吸烟[例(%)]	30(14.5)	26(21.0)	2.313	0.128
高血压[例(%)]	72(34.8)	64(51.6)	9.075	0.003
糖尿病[例(%)]	16(7.7)	21(16.9)	6.619	0.010
高血脂[例(%)]	19(9.2)	24(19.5)	7.270	0.007
冠心病家族史[例(%)]	9(4.3)	9(7.3)	1.277	0.258
血生化指标
血小板(×10⁹/L)	208.30±51.93	203.58±55.00	0.755	0.451
空腹血糖(mmol/L)	5.61±1.35	5.80±1.63	-1.018	0.309
TG(mmol/L)	1.89±0.82	2.02±0.88	-0.568	0.556
TC(mmol/L)	3.92±0.84	4.15±0.89	-0.604	0.435
LDL-C(mmol/L)	2.88±0.72	2.94±0.89	-0.610	0.542
胱抑素C(mg/L)	0.86±0.18	0.97±0.17	-5.507	<0.01

表2 不同冠脉病变支数亚组胱抑素C水平比较 ($bar{x} pm s$,mg/L)

Tab. 2 Comparison of cystatin C in different coronary artery lesions subgroups ($bar{x} pm s$, mg/L)

组别	例数	胱抑素C
单支	46	0.82±0.14
双支	42	0.93±0.16
三支	36	1.03±0.18
χ²值		12.304
$P$ 值		0.018

表2 不同冠脉病变支数亚组胱抑素C水平比较 ($bar{x} pm s$,mg/L)

Tab. 2 Comparison of cystatin C in different coronary artery lesions subgroups ($bar{x} pm s$, mg/L)

组别	例数	胱抑素C
单支	46	0.82±0.14
双支	42	0.93±0.16
三支	36	1.03±0.18
χ²值		12.304
$P$ 值		0.018

表3 不同病因的冠脉病变亚组胱抑素C水平比较 ($bar{x} pm s$,mg/L)

Tab. 3 Comparison of cystatin C in subgroups of coronary artery disease with different causes ($bar{x} pm s$, mg/L)

组别	例数	胱抑素C
慢血流	4	0.88±0.13
扩张性病变	5	0.87±0.14
冠脉肌桥	13	0.84±0.14
χ²值		1.324
$P$ 值		0.326

表3 不同病因的冠脉病变亚组胱抑素C水平比较 ($bar{x} pm s$,mg/L)

Tab. 3 Comparison of cystatin C in subgroups of coronary artery disease with different causes ($bar{x} pm s$, mg/L)

组别	例数	胱抑素C
慢血流	4	0.88±0.13
扩张性病变	5	0.87±0.14
冠脉肌桥	13	0.84±0.14
χ²值		1.324
$P$ 值		0.326

表4 非阻塞性冠脉疾病与临床指标的多元逻辑回归分析

Tab. 4 Multiple logistic regression analysis of nonobstructive coronary artery disease and clinical indicators

项目	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
年龄	0.918	0.201	10.351	0.003	2.331	1.532~5.023
性别	0.951	0.234	11.155	0.001	2.587	1.481~4.591
高血压	0.386	0.198	2.108	0.147	1.472	0.847~2.480
糖尿病	0.749	0.165	3.754	0.053	2.115	0.991~4.514
高血脂	1.327	0.323	13.203	0.000	3.770	1.843~7.713
胱抑素C	1.939	0.421	5.575	0.018	6.953	1.390~34.773

表4 非阻塞性冠脉疾病与临床指标的多元逻辑回归分析

Tab. 4 Multiple logistic regression analysis of nonobstructive coronary artery disease and clinical indicators

项目	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
年龄	0.918	0.201	10.351	0.003	2.331	1.532~5.023
性别	0.951	0.234	11.155	0.001	2.587	1.481~4.591
高血压	0.386	0.198	2.108	0.147	1.472	0.847~2.480
糖尿病	0.749	0.165	3.754	0.053	2.115	0.991~4.514
高血脂	1.327	0.323	13.203	0.000	3.770	1.843~7.713
胱抑素C	1.939	0.421	5.575	0.018	6.953	1.390~34.773

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