冠心病患者血清PAPP-A和sCD40L水平在诊断冠状动脉粥样硬化易损斑块中的价值分析

摘要

目的:探讨冠心病患者血清妊娠相关蛋白(PAPP-A)、可溶性白细胞分化抗原40配体(sCD40L)在诊断冠状动脉粥样硬化易损斑块中的价值.方法:选取2011年11月至2014年11月在广西壮族自治区南溪山医院住院治疗的冠心病患者304例,入院时分别进行血清PAPP-A、sCD40L水平检测及冠状动脉CT血管造影(CTA)检查,分析PAPP-A、sCD40L水平对冠脉易损斑块的诊断价值.结果:304例患者中,CTA检查有易损斑块105例,无易损斑块199例;易损斑块组血清PAPP-A和sCD40L水平明显高于非易损斑块组(P＜0.05).ROC曲线显示:将PAPP-A浓度0.9μg/L作为最佳临界值,诊断冠脉粥样硬化易损斑块的灵敏度为92.2％,特异度为87.3％,ROC曲线下面积(AUC)为0.902;将sCD40L浓度8.0mg/L作为最佳临界值,诊断冠脉粥样硬化易损斑块的灵敏度为89.0％,特异度为83.1％,AUC为0.812;两者AUC比较差异具有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,PAPP-A＞0.9μg/L、sCD40L＞ 8.0 mg/L均为冠状动脉易损斑块的独立预测因子(OR=2.49,95％ CI:1.15～5.36,P=0.01;OR=1.97,95％ CI:1.03～3.16,P=-0.03).结论:PAPP-A和sCD40L水平在冠状动脉易损斑块患者中明显升高,可作为冠心病患者冠状动脉斑块不稳定的预测指标,且PAPP-A的预测价值优于sCD40L.%Objective:To investigate the diagnostic value of serum pregnancy associated plasma protein (PAPP-A) and soluble cell differentiation antigen 40 ligand (sCD40L) levels for coronary vulnerable plaque.Methods:304 patient with coronary heart disease (CHD)admitted in our hospital from November 2011 to November 2014 were selected.All patients received PAPP-A and sCD40L detection and coronary CT angioplasty (CTA).The value of PAPP-A and sCD40L in the diagnosis of coronary atherosclerotic plaques was analyzed.Results:Of 304 patients,105 cases were indentified with vulnerable plaques.Patients with vulnerable plaques had higher levels of PAPP-A and sCD40L than those without (P＜ 0.05).ROC curve showed that the sensitivity and specificity of PAPP-A were respectively 92.2％ and 87.3％ in the diagnosis of coronary vulnerable plaque,with a cut-off value of 0.9 tg/L.The sensitivity and specificity of sCD40L were respectively 89.0％ and 83.1％,with a cut-offvalue of 8.0 mg/L.The area under the ROC curve(AUC)of PAPP-A(0.902) was higher than that of sCD40L (0.812) (P＜ 0.05).The multivariate logistic regression analysis revealed that PAPP-A ＞ 0.9 μg/L and sCD40L ＞ 8.0 mg/L were independent risk factors for coronary vulnerable plaque (OR=2.49,95％ CI:1.15-5.36,P=0.01;OR=1.97,95％ CI:1.03-3.16,P=0.03).Conclusions:The levels of PAPP-A and sCD40L in serum were significantly increased in patients with coronary vulnerable plaques.PAPP-A and sCD40L could be the important predictors for coronary vulnerable plaque in patients with CHD,and PAPP-A was more valuable.