Objective To analyze the diagnostic value of metabolomic changes to different types of coronary artery disease (CAD). Methods The hospitalized patients (n=1086, male 712 and female 374) were chosen from the departments of geriatrics in the Emergency Center of Chongqing City, Tumor Hospital of Chongqing City, Chinese PLA 324 Hospital and the Third People's Hospital of Chongqing City from Jan. 2003 to Jan. 2016. All patients were divided, according to symptoms and examination results, into normal coronary artery group (NCA group, n=116, without coronary stenosis), non-occlusion coronary atherosclerosis group (NOCA group, n=276, coronary stenosis<50%), acute myocardial infarction group (AMI group, n=324), unstable angina group (UA group, n=307) and stable angina group (SA group, n=63). The mass spectra peaks of metabolites in different blood samples were detected by using liquid chromatography-tandem mass spectrometry (LC-MS) for determining all metabolites. Results There were 12 cross comparisons conducted aiming at metabolic disorders of CAD, and 89 different metabolites identified. The changes of metabolic pathways included increase of phospholipid metabolism, decrease of amino acid metabolism, increase of short chain acyl carnitine, decrease of three-carboxylic acid cycle, and decrease of primary bile acid synthesis. The results of receiver operating characteristic curve (ROC) in reviewing diagnostic value of varying metabolites in all groups showed that area under curve (AUC) was 0.952, sensitivity was 94.2% and specificity was 80.7% in NOCA group and NCA group (n=392), 0.993, 96.4% and 95.6% in SA group and NOCA group (n=339), 0.990, 97.4% and 91.1% in UA group and SA group (n=370), and 0.992, 94.5% and 95.3% in AMI group and UA group (n=631). Conclusion The patients with different types of CAD will suffer from metabolic disorders. The changes of small molecular metabolites have potential value in the antidiastole of CAD.%目的 分析代谢产物变化对不同类型冠状动脉疾病(CAD)的诊断价值.方法 选自重庆市急救中心、重庆市肿瘤医院、解放军第三二四医院及重庆市第三人民医院等4所医院老年病科于2003年1月~2016年1月住院患者1086例,男性712例,女性374例.依据症状和检查结果分为:对照组(NCA组,116例,无冠状动脉狭窄)、非阻塞性冠状动脉粥样硬化组(NOCA组,276例,冠状动脉狭窄<50%)、急性心肌梗死组(AMI组,324例)、不稳定型心绞痛组(UA组,307例)和稳定型心绞痛组(SA组,63例).液相色谱-质谱联用(LC-MS)检测不同血样中代谢产物的质谱峰,从而确定其中所有的代谢产物.结果 针对CAD代谢紊乱做了12个交叉比较,对89种不同的代谢产物进行鉴定.代谢途径的改变包括磷脂代谢增加,氨基酸代谢降低,短链酰基肉碱增多,三羧酸循环减少,原发性胆汁酸合成减少.受试者工作特征曲线(ROC)评估各组对比有差异的代谢产物诊断价值,有差异的代谢产物诊断NOCA与NCA(n=392)的曲线下面积(AUC)、敏感性和特异性分别为0.952、94.2%和80.7%;SA与NOCA(n=339)分别为0.993、96.4%和95.6%;UA与SA(n=370)分别为0.990、97.4%和91.1%;AMI与UA(n=631)分别为0.992、94.5%和95.3%.结论 不同类型冠状动脉疾病患者发生代谢紊乱,小分子代谢产物的变化对冠状动脉疾病的鉴别诊断具有潜在价值.
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