25-(OH)D3与冠心病患者冠状动脉狭窄程度的相关性

doi:10.3969/j.issn.1004-583X.2021.11.004

摘要/Abstract

摘要：

目的研究25-(OH)D₃与冠心病患者冠状动脉狭窄程度之间是否具有相关性。方法接受了冠状动脉造影术(CAG)的216例患者,根据是否达到冠心病诊断标准与Gensini积分高低分为4组:对照组(43例)、轻度狭窄组(73例)、中度狭窄组(53例)、重度狭窄组(47例)。分别检测25-(OH)D₃、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、肌酐(Cr)等指标。结果 4组在25-(OH)D₃、男性、HDL-C、LDL-C、TC、TG的差异有统计学意义(P<0.05); 25-(OH)D₃与Gensini积分存在负相关关系(r=-0.355, P<0.001);多元logistic回归提示:高水平的25-(OH)D₃对于冠状动脉狭窄具有保护意义(B=-0.084, P<0.001);ROC曲线表明25-(OH)D₃对于冠心病发生及冠状动脉严重狭窄具有较强的预测价值,前者曲线下面积(AUC)为0.74(95%CI:0.663~0.817), 最佳临界值为17.57 ng/ml, 敏感度为74.4%,特异度为72.3%;后者AUC为0.72(95%CI:0.636~0.804), 最佳临界值为11.42 ng/ml, 敏感度为63.8%,特异度为74.6%。结论 25-(OH)D₃与冠状动脉狭窄程度之间呈负相关,较高水平的25-(OH)D₃对冠状动脉狭窄具有一定的保护作用,对于重度狭窄的诊断能力明显强于轻度及中度狭窄。

关键词: 冠心病, 冠状动脉狭窄, 维生素D, 冠状血管造影术

Abstract:

Objective To study the correlation between 25-(OH)D₃ and the degree of coronary artery stenosis in patients with coronary heart disease(CHD).Methods Totally 216 patients who underwent coronary angiography(CAG) were divided into control group (43 cases), mild stenosis group (73 cases), moderate stenosis group (53 cases), and severe stenosis group (47 cases) on the basis of the diagnostic criteria for CHD and the Gensini score. The key observations were 25-(OH)D₃, total cholesterol(TC), high density lipoprotein-cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C), triglyceride(TG), creatinine(Cr) and other indicators. Results Among the four groups, the differences were statistical significance in 25-(OH)D₃, male, HDL-C, LDL-C, TC and TG (P<0.05). 25-(OH)D₃ was negatively correlated with Gensini score (r=-0.355, P<0.001). Multiple logistic regression showed that high 25-(OH)D₃ was protective against coronary stenosis (B=-0.084, P<0.001). Receiver operating characteristic(ROC) curve showed that 25-(OH)D₃ had strong predictive value for the occurrence of CHD and severe coronary stenosis. Area under curve(AUC) of the former and the latter was respectively 0.74(95%CI: 0.663-0.817) and 0.72 (95%CI: 0.636-0.804),respectively; the optimal cut-off value was 17.57 ng/ml and 11.42 ng/ml, the sensitivity was 74.4% and 63.8%, and the specificity was 72.3% and 74.6%.Conclusion 25-(OH)D₃ had negative correlation with the degree of coronary stenosis. Higher 25-(OH)D₃ had a certain protective effect on coronary stenosis. The diagnosis for severe stenosis is significantly higher than for mild and moderate.

Key words: coronary disease, coronary stenosis, vitamin D, coronary angiography

中图分类号:

R541.4

赵伟凤, 马春宇. 25-(OH)D₃与冠心病患者冠状动脉狭窄程度的相关性[J]. 临床荟萃, 2021, 36(11): 981-985.

Zhao Weifeng, Ma Chunyu. Correlation between 25-(OH)D₃ and degree of coronary artery stenosis in patients with coronary heart disease[J]. Clinical Focus, 2021, 36(11): 981-985.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.11.004

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I11/981

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参考文献 22

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组别	例数	男性 [例(%)]	年龄 (岁)		BMI (kg/m²)			吸烟 [例(%)]		饮酒 [例(%)]		高血压 [例(%)]			糖尿病 [例(%)]
对照组	43	16(37.2)	60.3±9.70		25.48±3.67			10(23.3)		8(18.6)		23(53.3)			8(18.6)
轻度狭窄	73	48(65.8)^*	60.15±9.58		24.73±3.40			33(45.2)^*		29(39.7)		41(56.2)			23(31.5)
中度狭窄	53	36(67.9)^*	60.68±9.61		25.04±3.31			23(43.4)^*		14(26.4)		36(67.9)			17(32.1)
重度狭窄	47	33(70.2)^*	60.59±12.30		26.14±4.49			24(51.1)^*		13(27.7)		27(57.4)			14(29.8)
统计值		χ²=13.713	F=0.040		F=1.459		χ²=8.146		χ²=6.426		χ²=2.567			χ²=2.745
P值		0.030	0.989		0.227		0.043		0.093		0.463			0.433
组数	例数	25-(OH)D₃ (ng/ml)		HDL-C (mmol/L)	Cr (μmol/L)	LDL-C (mmol/L)			TG (mmol/L)				TC (mmol/L)			尿素 (mmol/L)
对照组	43	19.58±5.76		1.19±0.17	65.35±16.28	2.58±0.63			1.81±1.06				3.01±0.55			4.56±1.22
轻度狭窄	73	15.68±6.87		1.06±0.19^*	70.74±18.67	2.47±0.65			2.28±0.95				3.02±0.46			5.19±1.31
中度狭窄	53	15.54±7.19		0.95±0.13^*△	75.86±22.57	3.16±0.15^*△			3.30±0.18^*△				3.90±0.72^*△			5.18±1.73
重度狭窄	47	11.71±5.76^*△▲		0.95±0.31^*△	84.20±66.03	3.70±0.79^*△▲			11.71±5.76^*△▲				4.75±0.70^*△▲			5.34±1.76
统计值		F=11.247		F=14.079	F=2.432	H=73.601			H=111.123				H=105.583			H=6.589
P值		<0.01		<0.01	0.066	<0.01			<0.01				<0.01			0.086

组别	例数	男性 [例(%)]	年龄 (岁)		BMI (kg/m²)			吸烟 [例(%)]		饮酒 [例(%)]		高血压 [例(%)]			糖尿病 [例(%)]
对照组	43	16(37.2)	60.3±9.70		25.48±3.67			10(23.3)		8(18.6)		23(53.3)			8(18.6)
轻度狭窄	73	48(65.8)^*	60.15±9.58		24.73±3.40			33(45.2)^*		29(39.7)		41(56.2)			23(31.5)
中度狭窄	53	36(67.9)^*	60.68±9.61		25.04±3.31			23(43.4)^*		14(26.4)		36(67.9)			17(32.1)
重度狭窄	47	33(70.2)^*	60.59±12.30		26.14±4.49			24(51.1)^*		13(27.7)		27(57.4)			14(29.8)
统计值		χ²=13.713	F=0.040		F=1.459		χ²=8.146		χ²=6.426		χ²=2.567			χ²=2.745
P值		0.030	0.989		0.227		0.043		0.093		0.463			0.433
组数	例数	25-(OH)D₃ (ng/ml)		HDL-C (mmol/L)	Cr (μmol/L)	LDL-C (mmol/L)			TG (mmol/L)				TC (mmol/L)			尿素 (mmol/L)
对照组	43	19.58±5.76		1.19±0.17	65.35±16.28	2.58±0.63			1.81±1.06				3.01±0.55			4.56±1.22
轻度狭窄	73	15.68±6.87		1.06±0.19^*	70.74±18.67	2.47±0.65			2.28±0.95				3.02±0.46			5.19±1.31
中度狭窄	53	15.54±7.19		0.95±0.13^*△	75.86±22.57	3.16±0.15^*△			3.30±0.18^*△				3.90±0.72^*△			5.18±1.73
重度狭窄	47	11.71±5.76^*△▲		0.95±0.31^*△	84.20±66.03	3.70±0.79^*△▲			11.71±5.76^*△▲				4.75±0.70^*△▲			5.34±1.76
统计值		F=11.247		F=14.079	F=2.432	H=73.601			H=111.123				H=105.583			H=6.589
P值		<0.01		<0.01	0.066	<0.01			<0.01				<0.01			0.086

项目	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
项目	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
HDL-C	-3.622	0.685	27.919	0.000	0.027	-4.966	-2.278
TC	2.095	0.227	85.451	0.000	8.125	1.651	2.540
25-(OH)D₃	-0.084	0.022	14.052	0.000	0.919	-0.128	-0.040
男性	0.701	0.296	5.589	0.018	2.016	1.282	1.200

项目	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
项目	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
HDL-C	-3.622	0.685	27.919	0.000	0.027	-4.966	-2.278
TC	2.095	0.227	85.451	0.000	8.125	1.651	2.540
25-(OH)D₃	-0.084	0.022	14.052	0.000	0.919	-0.128	-0.040
男性	0.701	0.296	5.589	0.018	2.016	1.282	1.200

25-(OH)D₃与冠心病患者冠状动脉狭窄程度的相关性

Correlation between 25-(OH)D₃ and degree of coronary artery stenosis in patients with coronary heart disease

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