冠心病患者血清胱抑素C及血管内皮功能指数与冠状动脉病变程度的关系研究

摘要

目的 研究冠状动脉粥样硬化性心脏病(冠心病,CHD)患者血清胱抑素C(Cys C)及血管内皮功能指数与冠状动脉(冠脉)病变程度的关系.方法 选择从2015年2月~2017年12月于武警北京总队医院接受治疗的疑似为CHD并实施冠状动脉造影诊断的200例患者作为研究对象.根据冠状动脉造影的结果显示共有152例CHD患者,为观察组.冠状动脉病变情况:单支55例,双支57例,多支40例.另48例非CHD患者,为对照组.根据狭窄程度(Gensini)积分将观察组划分亚组:Gensini积分≥82分(高分组)37例,32~81分(中分组)64例,≤31分(低分组)51例.对比两组临床资料,分析不同支数的冠状动脉病变患者及不同冠状动脉Gensini积分患者的Cys C及反应性充血指数(RHI)水平的相关性.结果 观察组的Cys C水平高于对照组,RHI水平低于对照组(P＜0.05).双支及以上病变患者Cys C水平明显高于单支病变者,而多支病变者高于双支病变者;双支病变和多支病变患者的RHI水平明显低于单支病变者,而多支病变者低于双支病变者,差异均有统计学意义(P均＜0.05).中分组和高分组患者的Cys C水平明显高于低分组,而高分组又高于中分组;中分组和高分组患者的RHI水平明显低于低分组,而高分组又低于中分组,差异均有统计学意义(P均＜0.05).Spearman法分析结果发现患者的冠状动脉病变支数及Gensini积分均与Cys C呈正相关(P＜0.05),与RHI呈负相关(P＜0.05).结论 CHD患者的血清Cys C升高、RHI降低与冠状动脉病变支数及Gensini积分具有较强的相关性,临床上可将Cys C和RHI纳入到CHD的监测指标体系中,从而可更加全面地服务于诊治过程.%Objective To study the relationship among serum cystatin C (Cys C), vascular endothelial function indexes and severity of coronary artery lesions in patients with coronary heart disease (CHD). Methods The patients (n=200) with suspected CHD received coronary angiography (CAG) were chosen from Hospital of Beijing General Unit of Chinese People’s Armed Police from Feb. 2015 to Dec. 2017. The results of CAG showed that there were 152 CHD patients (observation group), and among them 55 with 1-vessel lesion, 57 with 2-vessel lesions and 40 with multi-vessel lesions. Other 48 non-CHD patients were chosen as control group. The observation group were divided, according to Gensini integrals, into high-integral subgroup (Gensini integral≥82, n=37), mid-integral subgroup (Gensini integral=32-81, n=64) and low-integral subgroup (Gensini integral≤31, n=51). The clinical data was compared, and correlation among CysC, reactive hyperemia index (RHI) and severity of coronary artery lesions were analyzed in all groups. Results The level of CysC was higher and RHI level was lower in observation group than those in control group (P<0.05). The level of CysC was significantly higher in patients with 2-vessel lesions and multi-vessel lesions than that in patients with 1-vessel lesion, and was higher in patients with multi-vessel lesions than that in patients with 2-vessel lesions. The level of RHI was significantly lower in patients with 2-vessel lesions and multi-vessel lesions than that in patients with 1-vessel lesion, and was lower in patients with multi-vessel lesions than that in patients with 2-vessel lesions (all P<0.05). The level of CysC was significantly higher in mid-integral subgroup and high-integral subgroup than that in low-integral subgroup, and was higher in high-integral subgroup than that in mid-integral subgroup. The level of RHI was significantly lower in mid-integral subgroup and high-integral subgroup than that in low-integral subgroup, and was lower in high-integral subgroup than that in mid-integral subgroup (all P<0.05). The results of Spearman analysis showed that numbers of lesion vessels and Gensini integrals were positively correlated to CysC (P<0.05) and negatively correlated to RHI (P<0.05). Conclusion The increase of serum CysC level and decrease of RHI level are closely correlated to numbers of lesion vessels and Gensini integrals in CHD patients, and CysC and RHI can be included in monitoring index system of CHD for serving diagnosis and treatment process more comprehensively.