Changes and significance of red blood cell distribution width, blood uric acid, D-Dimer and B-ype natriuretic peptide in acute coronary syndrome
-
摘要:
目的 研究红细胞分布宽度(RDW)、血尿酸(BUA)、D-二聚体(D-Dimer)和B型利钠肽(BNP)水平在急性冠脉综合征(ACS)中的意义。 方法 收集2017年1月—2019年3月因ACS在蚌埠市第三人民医院住院行冠脉造影的171例患者为试验组，取同期冠脉造影或冠脉CT无明显异常患者65例为对照组，比较2组RDW、BUA、D-二聚体和BNP。试验组采用Gensini评分分组，分析各组4项指标；按患者住院期间的心血管不良事件发生情况(MACE)分组，分析各组4项指标。采用logistic回归分析研究4项指标与ACS的关系。 结果 试验组RDW、BUA、D-二聚体和BNP水平均高于对照组(均P＜0.01)；不同Gensini评分各组RDW、D-二聚体和BNP差异均有统计学意义(均P＜0.01)；不同MACE组内4项指标差异有统计学意义(均P＜0.01)。Logistic回归分析示4项指标均与ACS相关，灵敏度分别为0.468、0.544、0.655、0.404，特异度为0.738、0.662、0.708、0.754，AUC为0.610、0.617、0.670、0.584，4项指标组成联合因子灵敏度为0.731，特异度为0.631，AUC为0.714。 结论 RDW、BUA、D-二聚体和BNP与ACS患者病情相关，4项指标联合检测在ACS诊断中有临床意义。 Abstract:Objective To study the significance of red blood cell distribution width (RDW), blood uric acid (BUA), D-Dimer and B-type natriuretic peptide (BNP) levels in acute coronary syndrome (ACS). Methods Total 171 patients with ACS who underwent coronary angiography in the Third People's Hospital of Bengbu City from January 2017 to March 2019 were collected as experimental group, and 65 patients with no obvious abnormalities in coronary angiography or coronary CT during the same period were selected as controls group. The RDW, BUA, D-Dimer and BNP of the two groups were compared. The experimental group was divided into groups by Gensini score, and 4 indicators of each group were analyzed. The patients were grouped according to the adverse cardiovascular events (MACE) during hospitalization, and 4 indicators in each group were analyzed. Logistic regression was used to analyze the relationship between 4 indicators and ACS. Results The levels of RDW, BUA, D-Dimer and BNP in the experimental group were higher than those in the control group (all P < 0.01). Gensini scores were different in each group in RDW, D-Dimer and BNP (all P < 0.01). There were differences in 4 indicators in the MACE group (all P < 0.01). Logistic regression analysis showed that the 4 indicators were all related to ACS, the sensitivity were 0.468, 0.544, 0.655 and 0.404, the specificity were 0.738, 0.662, 0.708 and 0.754, and the area under the curve (AUC) were 0.610, 0.617, 0.670 and 0.584, respectively. The sensitivity of the combination factor composed of four indicators was 0.731, the specificity was 0.631, and the AUC was 0.714. Conclusion RDW, BUA, D-Dimer and BNP are related to the condition of ACS patients. The combined detection of 4 indicators has clinical significance in ACS. -
图 1 BUA、D-二聚体、BNP和RDW及四者联合预测ACS的ROC曲线
Figure 1. The ROC curves of BUA, D- dimer, BNP, RDW and their combined prediction of ACS
表 1 Gensini评分方法
Table 1. Gensini scoring method
狭窄程度 评分 病变部位 评分 1%~25% 1 左主干 5.0 26%~50% 2 左前降支或回旋支近端 2.5 51%~75% 4 左前降支中段 1.5 76%~90% 8 左前降支远端左回旋支中/远端 1.0 91%~99% 16 右冠状动脉 1.0 全闭 32 小分支 0.5 
下载: 导出CSV
表 2 2组患者基本资料比较
Table 2. The basic data of the two groups were compared
组别 例数 性别(男/女，例) 年龄(x±s，岁) BMI (x±s) Hb (x±s，g/L) TC (x±s，mmol/L) LDL-C (x±s，mmol/L) FPG (x±s，mmol/L) SCr (x±s，μmol/L) 试验组 171 92/79 56.63±10.38 24.58±3.21 129.11±18.01 2.48±0.91 3.05±1.08 8.63±2.39 85.27±25.40 对照组 65 35/30 54.68±10.54 24.63±3.10 132.94±15.04 2.72±0.79 2.88±1.00 8.35±2.14 80.85±24.44 统计量 < 0.001a 1.283b -0.112b -1.523b -1.871b 1.183b 0.802b 1.207b P值 0.995 0.201 0.911 0.129 0.063 0.238 0.423 0.228 注：a为χ2值，b为t值。
下载: 导出CSV
表 3 不同诊断类型ACS患者既往用药及合并相关疾病情况比较(例)
Table 3. Comparison of previous drug use and related diseases in patients with different diagnosis types of ACS (cases)
诊断类型 例数 高血压 糖尿病 高脂血症 曾服用抗血小板药物 曾服用他汀类药物 UAP 72 40 51 37 45 41 STEMI 56 30 41 35 40 33 NSTEMI 43 25 33 24 28 26 χ2值 0.206 0.479 1.582 1.144 0.144 P值 0.902 0.787 0.453 0.564 0.930
下载: 导出CSV
表 4 2组RDW、BUA、D-二聚体和BNP水平的比较(x±s)
Table 4. The levels of RDW, BUA, D- dimer and BNP in two groups(x±s)
组别 例数 RDW (%) BUA (μmol/L) D-二聚体(mg/L) BNP (ng/L) 对照组 65 26.13±7.19 298.22±63.14 0.21±0.05 74.01±14.83 试验组 171 34.36±8.72 327.70±54.41 0.27±0.08 194.37±96.28 t值 6.786 3.554 7.723 15.808 P值 < 0.001 < 0.001 < 0.001 < 0.001
下载: 导出CSV
表 5 不同Gensini评分组ACS患者RDW、BUA、D-二聚体和BNP水平比较(x±s)
Table 5. The levels of RDW, BUA, D- dimer and BNP in ACS patients with different Gensini scores(x±s)
组别 例数 RDW(%) BUA(μmol/L) D-二聚体(mg/L) BNP(ng/L) 轻度 62 30.12±7.50 316.63±45.25 0.22±0.06 139.10±39.26 中度 59 34.47±8.03 336.06±61.15 0.27±0.05 146.62±46.27 重度 37 38.23±5.76 331.17±60.33 0.33±0.07 303.24±66.12 极重度 13 43.14±12.47 332.77±38.61 0.38±0.05 364.87±70.60 F值 14.522 1.418 44.247 145.808 P值 < 0.001 0.239 < 0.001 < 0.001
下载: 导出CSV
表 6 不同MACE发生情况组ACS患者RDW、BUA和D-二聚体水平比较(x±s)
Table 6. Levels of RDW, BUA and D- dimer in ACS patients with different levels of MACE
不良事件 例数 RDW (%) BUA (μmol/L) D-二聚体(mg/L) BNP (ng/L) 心力衰竭 15 35.63±6.33 309.54±46.79 0.31±0.04 207.91±12.46 再发心绞痛 21 37.45±4.74 330.15±33.13 0.36±0.06 263.29±17.88 再发心肌梗死 8 42.54±10.43 343.64±43.68 0.47±0.10 305.06±8.48 心源性死亡 7 45.55±6.65 359.53±36.84 0.56±0.04 366.77±19.13 F值 4.770 2.933 34.613 186.05 P值 0.006 0.043 < 0.001 < 0.001
下载: 导出CSV
表 7 不同指标对ACS诊断的logistic回归分析
Table 7. Logistic regression analysis of different indexes for ACS diagnosis
项目 B SE Wald χ2 P值 OR(95% CI) BUA(μmol/L) 0.030 0.010 8.337 0.004 1.030(1.010~1.051) D-二聚体(mg/L) 0.033 0.013 7.053 0.008 1.034(1.009~1.060) BNP(ng/L) 0.048 0.019 6.023 0.014 1.049(1.010~1.089) RDW(%) 0.027 0.013 3.998 0.046 1.027(1.001~1.054)
下载: 导出CSV
表 8 各指标及四者联合对ACS的诊断价值
Table 8. The diagnostic value of each index and their combination in ACS
项目 AUC 最佳界值 灵敏度 特异度 截断值 BUA(μmol/L) 0.610 0.206 0.468 0.738 179.827 D-二聚体(mg/L) 0.617 0.205 0.544 0.662 0.250 BNP(ng/L) 0.670 0.363 0.655 0.708 100.343 RDW 0.584 0.157 0.404 0.754 32.342 联合因子(%) 0.714 0.362 0.731 0.631
下载: 导出CSV
-
[1] 高晓津, 杨进刚, 杨跃进, 等. 中国急性心肌梗死患者心血管危险因素分析[J]. 中国循环杂志, 2015, 30(3): 206-210. doi: 10.3969/j.issn.1000-3614.2015.03.003GAO X J, YANG J G, YANG Y J, et al. Factor analysis of cardiovascular risk in Chinese patients with acute myocardial infarction[J]. China Circular Journal, 2015, 30(3): 206-210. doi: 10.3969/j.issn.1000-3614.2015.03.003 [2] 叶志荣, 林勇军, 洪娜娇, 等. 传统心肌标志物联合2种新型心肌标志物在老年非ST段抬高急性冠脉综合征早期诊断和危险分层中的作用[J]. 中国老年学杂志, 2018, 38(21): 5131-5134. doi: 10.3969/j.issn.1005-9202.2018.21.006YE Z R, LIN Y J, HONG N J, et al. Traditional myocardial markers combined with two new myocartypes role of markers in the early diagnosis and risk stratification of non-ST elevation acute coronary syndrome in aging[J]. Chinese Journal of Gerontology, 2018, 38(21): 5131-5134. doi: 10.3969/j.issn.1005-9202.2018.21.006 [3] GENSINI G G. A more meaningful scoring system for determining the severity of coronary heart disease[J]. Am J Cardiol, 1983, 51(3): 606. doi: 10.1016/S0002-9149(83)80105-2 [4] 刘恒友, 鲁锦国, 刘小河, 等. 血脂控制水平RDW及ET-1与冠心病患者PCI术后支架内再狭窄的关系研究[J]. 河北医学, 2020, 26(4): 545-549. doi: 10.3969/j.issn.1006-6233.2020.04.005LIU H Y, LU J G, LIU X H, et al. Study of blood lipid control levels of RDW and ET-1 and coronary heart on the relationship of stent restenosis after PCI[J]. Hebei Medicine, 2020, 26(4): 545-549. doi: 10.3969/j.issn.1006-6233.2020.04.005 [5] 王艳飞, 赵春生, 于健, 等. 红细胞分布宽度与修正休克指数对非ST段抬高型心肌梗死预后的关系研究[J]. 河北医药, 2019, 41(16): 2494-2496, 2500. doi: 10.3969/j.issn.1002-7386.2019.16.024WANG Y F, ZHAO C S, YU J, et al. Study of red BC distribution width versus corrected shock index on the relationship of the prognosis of ST elevation myocardial infarction[J]. Hebei Medicine, 2019, 41(16): 2494-2496, 2500. doi: 10.3969/j.issn.1002-7386.2019.16.024 [6] 田磊, 王长谦, 韩志华, 等. 冠心病患者红细胞分布宽度与动脉硬化的相关性[J]. 心脏杂志, 2016, 28(1): 46-49. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ201601013.htmTIAN L, WANG C Q, HAN Z H, et al. Correlation of red blood cell distribution width and arterial stiffness in patients with coronary artery disease[J]. Heart Journal, 2016, 28(1): 46-49. https://www.cnki.com.cn/Article/CJFDTOTAL-XGNZ201601013.htm [7] 杨剑秋, 毕建洲. 红细胞分布宽度对肺部感染所致脓毒症预后的评估价值分析[J]. 中华全科医学, 2020, 18(11): 1827-1829. doi: 10.16766/j.cnki.issn.1674-4152.001629YANG J Q, BI J Z. Evaluation value analysis of the width of red blood cell distribution on the prognosis of sepsis caused by pulmonary infection[J]. Chinese general practice, 2020, 18(11): 1827-1829. doi: 10.16766/j.cnki.issn.1674-4152.001629 [8] INUZUKA R, ABE J. Red blood cell distribution width as a link between ineffective erythropoiesis and chronic inflammation in heart failure[J]. Circ J, 2015, 79(5): 974-975. doi: 10.1253/circj.CJ-15-0254 [9] 王晓旭, 葛平. 红细胞分布宽度对老年心力衰竭患者全因死亡的预测价值[J]. 现代医药卫生, 2021, 37(3): 447-452. doi: 10.3969/j.issn.1009-5519.2021.03.024WANG X X, GE P. Predictive value of red blood cell distribution width has died in elderly heart failure patients[J]. Modern medicine and Health care, 2021, 37(3): 447-452. doi: 10.3969/j.issn.1009-5519.2021.03.024 [10] TUNÇEZ A, ÇETIN M S, ÇETIN E H, et al. Association between RDW and stent thrombosis in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Medicine(Baltimore), 2017, 96(5): e5986. [11] 郭俊芳, 张宝伟, 陈蓉, 等. 血浆D-二聚体含量在急性主动脉夹层与非ST段抬高型急性冠脉综合征鉴别中的意义[J]. 江苏大学学报(医学版), 2018, 28(4): 316-319. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYZ201804009.htmGUO J F, ZHANG B W, CHEN R, et al. Significance of plasma D-dimer content is present in the acute aortic clamp of layer in the identification of non-ST elevation acute coronary syndrome[J]. Journal of Jiangsu University (Medical edition), 2018, 28(4): 316-319. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYZ201804009.htm [12] 徐源. 同型半胱氨酸、血肌酐、血尿酸和胱抑素C在急性心肌梗死中的水平变化及诊断意义[J]. 河北医药, 2019, 41(18): 2819-2822. doi: 10.3969/j.issn.1002-7386.2019.18.024XU Y. Level changes and diagnostic significance of homocysteine, blood creatinine, blood uric acid, and cystatin C in acute myocardial infarction[J]. Hebei Medicine, 2019, 41(18): 2819-2822. doi: 10.3969/j.issn.1002-7386.2019.18.024 [13] 宋宏界. 血尿酸水平与血脂的相关性研究[J]. 中国实用医药, 2016, 11(2): 32. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201602017.htmSONG H J. Study on the correlation of blood uric acid level and blood lipid[J]. Practical medicine in China, 2016, 11(2): 32. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201602017.htm [14] 刘琪. 痛风患者血尿酸水平与血小板相关参数及宽度与动脉硬化的相关性[J]. 心脏杂志, 2016, 28(1): 46.LIU Q. Correlation of blood uric acid level and platelet-related parameters and width and arterial stiffness in gout patients[J]. Heart Journal, 2016, 28(1): 46. [15] 李俊, 孙承谋, 施蓉. 急性冠脉综合征患者血尿酸水平与机体炎性反应及血管内皮功能关系分析[J]. 国际检验医学杂志, 2019, 40(4): 498-500. doi: 10.3969/j.issn.1673-4130.2019.04.031LI J, SUN C M, SI R. Analysis of blood uric acid level and body inflammation sexual response and vascular endothelial function in patients with acute coronary syndrome[J]. International Journal of Laboratory Medicine, 2019, 40(4): 498-500. doi: 10.3969/j.issn.1673-4130.2019.04.031 [16] 曾涛, 王艳芳. 冠脉介入治疗对冠心病急性心肌梗死患者心室重塑与BNP的影响[J]. 医药论坛杂志, 2019, 40(5): 63-65. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201905021.htmZENG T, WANG Y F. Effect of coronary intervention with severe ventricular remodeling and BNP in patients with acute myocardial infarction of coronary heart disease[J]. Pharmaceutical Forum magazine, 2019, 40(5): 63-65. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201905021.htm [17] 冯高科, NGUYEN T D, 蒋学俊. 老年冠心病患者血液中Hcy、IL-6及BNP表达水平与冠心病病变程度的关系[J]. 中华全科医学, 2019, 17(10): 1644-1646. doi: 10.16766/j.cnki.issn.1674-4152.001018FENG G K, NGUYEN T D, JIANG X J. The relationship between the blood expression levels of Hcy, IL-6 and BNP and the degree of CHD lesions in elderly patients with CHD disease[J]. Chinese general practice, 2019, 17(10): 1644-1646. doi: 10.16766/j.cnki.issn.1674-4152.001018 -
点击查看大图
图(1) / 表(8)
计量
- 文章访问数: 140
- HTML全文浏览量: 47
- PDF下载量: 1
- 被引次数: 0
