心外膜脂肪体积、尿微量白蛋白/肌酐比值及血清炎症因子水平与冠状动脉病变程度分析

Analysis on relationship of epicardial adipose tissue volume, urinary microalbumin/creatinine ratio and serum inflammatory factor levels with severity of coronary lesions

摘要:

目的 探讨冠心病患者心外膜脂肪组织体积(EATV)、尿微量白蛋白/肌酐比值(UACR)及血清炎症因子[脂蛋白相关磷脂酶A2(Lp-PLA2)、分形趋化因子(FKN)、肿瘤坏死因子－α(TNF-α)、基质金属蛋白酶－9(MMP-9)、胰岛素样生长因子-1(IGF-1)、血清胱抑素 C(Cys C)]指标水平与冠状动脉病变程度之间的关系。方法 入选2016年3月至2017年8月解放军总医院心血管内科收治的初诊冠心病且冠状动脉狭窄患者130例及未发现冠状动脉狭窄的非冠心病者(对照组)32例,冠状动脉CT狭窄者行冠状动脉造影明确病变,并计算冠状动脉介入与外科手术治疗间协同评估(SYNTAX)评分,根据SYNTAX评分将冠状动脉狭窄患者分为低(≤22分)、中(23~32分)、高(≥33分)3组。通过冠状动脉螺旋CT图像测算患者EATV,采用免疫比浊法及酶联免疫吸附试验检测UACR及血清炎症因子水平,分析4组患者EATV、UACR及血清炎症因子水平与冠状动脉病变的相关性。采用SPSS 17.0统计软件对数据进行分析。根据数据类型,采用单因素方差分析、卡方检验或精确概率法进行组间比较；相关性分析采用Pearson积距相关法,多因素分析采用logistic逐步回归法。结果 高评分组EATV、Lp-PLA2、FKN、MMP-9、Cys C及UACR水平显著高于其他3组,IGF-1水平显著高于对照组及中评分组,TNF-α水平显著高于对照组及低评分组,差异均有统计学意义(P＜0.05)。中评分组EATV、Lp-PLA2、MMP-9、TNF-α及UACR水平显著高于对照组及低评分组,IGF-1水平显著低于低评分组,FKN及Cys C水平显著高于对照组,差异均有统计学意义(P＜0.05)。低评分组EATV、IGF-1水平明显高于对照组,差异有统计学意义(P＜0.05)。经相关性分析,患者EATV(r=0.41)、UACR(r=0.69)、血清炎症因子Lp-PLA2(r=0.72)、IGF-1(r=0.25)、FKN(r=0.52)、TNF-α(r=0.49)、MMP-9(r=0.67)、Cys C(r=0.15) 与SYNTAX评分均呈正相关(P<0.05)。logistic逐步回归分析显示,IGF-1(OR=1.064,5%CI 1.024~1.106,P=0.002)、MMP-9(OR=1.049,5%CI 1.018~1.080,P=0.002)、Cys C(OR=797.355,5%CI 33.729~999.999,P=0.001)及EATV(OR=1.042,5%CI 1.018~1.067,P=0.005)为冠心病发病的危险因素。结论 冠心病患者的EATV越大,UACR及血浆炎症因子(Lp-PLA2、IGF-1、FKN、TNF-α、MMP-9、Cys C)水平越高,冠状动脉病变SYNTAX积分越高,冠状动脉病变程度越严重。IGF-1、MMP-9、Cys C、EATV可能是冠心病发病的危险因素。

Abstract:

Objective To investigate the relationship of epicardial adipose tissue volume (EATV), urinary microalbumin/creatinine ratio (UACR) and serum levels of inflammatory factors, including lipoprotein-associated phospholipase A2 (Lp-PLA2), fractalkine (FKN), tumor necrosis factor-α (TNF-α), matrix metaloproteinase-9 (MMP-9), insulin-like growth factor-1 (IGF-1), and cystatin C (Cys C), with severity of coronary lesions in coronary heart disease (CHD) patients. Methods A total of 130 patients with freshly-diagnosed coronary artery stenosis in our department from March 2016 to August 2017 were recruited in this study. Another 32 non-CHD patients without such stenosis served as control group. The patients with coronary artery stenosis were identified by coronary angiography, and through synergy between percutaneous coronary intervention (PCI) with TAXUS stent and cardiac surgery (SYNTAX), their SYNTAX scores were calculated. According to the score, the patients were assigned into low (≤22), moderate (23-32) and high score (≥33) groups. EATV was calculated based on coronary artery spiral CT images. Latex agglutination turbidimetric immunoassay and enzyme-linked immunosorbent assay were used to determine UACR and inflammatory factor levels. The relationship of EATV, UACR and serum levels of inflammatory factors with severity of coronary lesions were analyzed in 4 groups of patients. SPSS statistics 17.0 was used to perform the statistical analysis. Student′s t test, Chi-square test, or Fisher exact test was employed for comparison between groups based on different data types. Pearson product-moment correlation analysis was adopted for the correlation analysis, and logistic stepwise regression analysis for multiple factor analysis. Results The EATV, Lp-PLA2, FKN, MMP-9, Cys C levels and UACR were obviously higher in the high score group than the moderate and low score groups and control group (P<0.05). The high score group also had higher IGF-1 than the control and moderate score group and higher TNF-α than the control and low score group (both P<0.05). The moderate score group had significantly higher EATV, Lp-PLA2, MMP-9 and TNF-α levels and UACR than the control and low score group, lower IGF-1 than the low score group, but higher FKN and Cys C levels than the control group (P<0.05). While, the EATV and IGF-1 levels were notably higher in the low score group than control group (P<0.05). Correlation analysis showed that SYNTAX score was positively correlated with EATV (r=0.41), UACR (r=0.69), Lp-PLA2 (r=0.72), IGF-1 (r=0.25), FKN (r=0.52), TNF-α (r=0.49), MMP-9 (r=0.67) and Cys C (r=0.15). Logistic stepwise regression analysis indicated that IGF-1 (OR=1.064,5%CI 1.024-1.106, P=0.002), MMP-9 (OR=1.049,5%CI 1.018-1.080, P=0.002), Cys C (OR=797.355,5%CI 33.729-999.999, P=0.001) and EATV (OR=1.042,5%CI 1.018-1.067, P=0.005) were risk factors for CHD. Conclusion Larger EATV, higher UACR and higher serum levels of inflammatory factors (Lp-PLA2, IGF-1, FKN, TNF-α, MMP-9 and Cys C) indicate high score of SYNTAX and severe coronary lesions. IGF-1, MMP-9, Cys C and EATV might be risk factors for CHD.