| 摘要: |
| 目的 探讨血清CRP、载脂蛋白A1（ApoA1）及CRP与ApoA1比值（CRP/ApoA1）评估冠状动脉病变的价值。方法 回顾性连续纳入2018年12月至2019年12月因胸痛在中国人民解放军联勤保障部队904医院住院治疗并行冠状动脉造影检查的533例患者。根据Gensini积分和冠状动脉造影结果将患者分为冠状动脉正常组（Gensini积分为0分，n=118）、冠状动脉粥样硬化组（Gensini积分为1~18分但不满足冠心病诊断，n=109）和冠心病组（Gensini积分为1~180分且符合冠心病诊断标准，n=306）。依据Gensini积分将冠心病患者分为轻度病变组（Gensini评分为1~<30分，n=177）和重度病变组（Gensini评分为30~180分，n=129）。根据血管病变数目将冠心病患者分为冠状动脉单支血管病变组（n=147）、冠状动脉双支血管病变组（n=90）、冠状动脉3支及以上血管病变组（n=69）。记录各组患者的血清CRP、ApoA1、白蛋白等血液学指标，并计算CRP/ApoA1。采用多因素logistic二元回归分析确定冠心病及重度病变的独立危险因素，应用ROC曲线分析CRP/ApoA1对冠心病、冠心病重度病变、冠状动脉3支及以上血管病变的预测价值，并与CRP/白蛋白比值（CAR）、CRP和ApoA1的预测价值进行比较。结果 冠心病组患者的CRP/ApoA1高于冠状动脉正常组（P<0.01），冠心病重度病变组患者的CRP/ApoA1高于冠心病轻度病变组（P<0.01）。多因素logistic二元回归分析提示CRP/ApoA1是冠心病和冠心病重度病变的独立危险因素（OR=2.171，95% CI 1.293~3.647，P<0.01；OR=6.306，95% CI 3.591~11.073，P<0.01）。Spearman相关性分析结果表明CRP/ApoA1与Gensini积分呈正相关（r=0.419，P<0.01），且CRP/ApoA1与冠状动脉病变血管支数呈正相关（r=0.431，P<0.05）。ROC曲线分析结果显示，CRP/ApoA1对冠心病、冠心病重度病变和冠状动脉3支及以上血管病变有较高的预测价值（AUC值分别为0.704、0.796、0.820），且均优于CAR（AUC值分别为0.684、0.783、0.806）、CRP（AUC值分别为0.682、0.778、0.800）和ApoA1（AUC值分别为0.641、0.669、0.687），差异均有统计学意义（P均<0.05）。结论 CRP/ApoA1与冠心病及其病变严重程度相关，其诊断价值优于CAR、CRP、ApoA1，可用于冠心病的诊断与病情评估。 |
| 关键词: C反应蛋白 载脂蛋白A1 Gensini积分 冠状动脉疾病 |
| DOI：10.16781/j.0258-879x.2021.10.1148 |
| 投稿时间：2021-04-18修订日期：2021-08-26 |
| 基金项目:江苏省基础研究计划（自然科学基金）面上项目（BK20201139），无锡市科学技术局医疗与公众健康技术创新应用项目（N20202035）. |
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| Correlation of serum C reactive protein to apolipoprotein A1 ratio with coronary artery disease: a preliminary study |
| WU Zu-fei1,CHEN Shi1,SU Wen-tao1,ZHOU Yu-ting1,ZONG Gang-jun1,2,WU Gang-yong1,2* |
(1. Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi 214044, Jiangsu, China;
2. Department of Cardiovasology, No. 904 Hospital of Joint Logistics Support Force of PLA, Wuxi 214044, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the value of serum C reactive protein (CRP), apolipoprotein A1 (ApoA1), and CRP to ApoA1 ratio (CRP/ApoA1) in evaluating coronary artery disease. Methods A total of consecutive 533 patients who were hospitalized due to chest pain and examined by coronary angiography in the No. 904 Hospital of Joint Logistics Support Force of PLA from Dec. 2018 to Dec. 2019 were retrospectively included. According to the Gensini score and coronary angiography results, the patients were divided into normal coronary artery group (Gensini score of 0, n=118), coronary atherosclerosis group (Gensini score of 1-18 but not meeting the diagnostic criteria of coronary heart disease[CHD], n=109) and CHD group (Gensini score of 1-180 and meeting the diagnostic criteria of CHD, n=306). According to the Gensini score, the CHD patients were divided into mild CHD group (Gensini score of 1-<30, n=177) and severe CHD group (Gensini score of 30-180, n=129). According to the lesion vessel number, the CHD patients were divided into single-vessel lesion group (n=147), double-vessel lesion group (n=90) and 3 or more vessel lesion group (n=69). The hematological indexes such as serum CRP, ApoA1 and albumin were recorded in each group, and CRP/ApoA1 was calculated. Multivariate logistic binary regression analysis was used to determine the independent risk factors of CHD and severe CHD. Receiver operating characteristic (ROC) curve was used to analyzed the predictive value of CRP/ApoA1 on CHD, severe CHD and 3 or more vessel lesions, and the differences from CRP to albumin ratio (CAR), CRP and ApoA1 were observed. Results The CRP/ApoA1 of the CHD group was significantly higher than that of the normal coronary artery group (P<0.01), and the CRP/ApoA1 of the severe CHD group was significantly higher than that of the mild CHD group (P<0.01). Multivariate logistic binary regression analysis suggested that CRP/ApoA1 was an independent risk factor of CHD and severe CHD (odds ratio[OR]=2.171, 95% confidence interval[CI] 1.293-3.647, P<0.01; OR=6.306, 95% CI 3.591-11.073, P<0.01). Spearman correlation analysis showed that CRP/ApoA1 was positively correlated with Gensini score (r=0.419, P<0.01) and lesion vessel number (r=0.431, P<0.05). ROC curve analysis showed that CRP/ApoA1 had good predictive value for CHD, severe CHD and 3 or more vessel lesions (area under curve[AUC]=0.704, 0.796 and 0.820), and was significantly better than that of CAR, CRP and ApoA1 (AUC=0.684, 0.783, 0.806; 0.682, 0.778, 0.800; and 0.641, 0.669, 0.687) (all P<0.05). Conclusion CRP/ApoA1 is related to CHD and its severity, and its diagnostic value is higher than that of CAR, CRP and ApoA1. It can be used in the diagnosis and evaluation of CHD. |
| Key words: C reactive protein apolipoprotein A1 Gensini score coronary artery disease |
