AnxA1、ADAMTS13联合心电图参数对急性心肌梗死患者冠脉狭窄程度及斑块稳定性的评估价值

Evaluation AnxA1， ADAMTS13 Combined with Electrocardiogram Parameters for the Degree of Coronary Artery Stenosis and Plaque Stability in Patients with Acute Myocardial Infarction

摘要

目的 探究血清膜联蛋白A1（annexin A1， AnxA1）、血管性血友病因子裂解蛋白酶（a disintegrin-like and metalloproteinase with thrombospond in type-1 domain 13， ADAMTS13）联合心电图参数对急性心肌梗死（acute myocardial infarction， AMI）患者冠脉狭窄程度及斑块稳定性的评估价值。 方法 选取2020年8月至2022年8月在本院收治的280例因胸痛入院，疑似AMI患者作为研究对象，根据肌钙蛋白（cardiac troponin I， cTnl）水平和冠状动脉造影的检查结果分为AMI组（145例）和非AMI组（135例），比较两组血清AnxA1、ADAMTS 13水平；根据AMI患者冠脉狭窄程度（gensini）评分结果分为轻度组（55例）、中度组（53例）和重度组（37例），比较不同冠状动脉病变支数及不同冠脉病变程度患者血清AnxA1、ADAMTS13水平。采用受试者工作曲线（receiver operating characteristic curve， ROC）分析血清AnxA1、ADAMTS13联合心电图对AMI重度冠脉病变以及斑块稳定性的预测价值。 结果 与非AMI组比较，AMI组患者血清AnxA1、QTc、TP-Tec水平升高［（0.97 ± 0.26 ）vs （1.31 ± 0.38） μg/mL］ ［（417.56 ± 29.11 ） vs （456.88 ± 28.62） ms］ ［（106.53 ± 15.28） vs （120.48 ± 14.91） ms］，ADAMTS13水平降低［（1.22 ± 0.39） vs（0.86 ± 0.29 ）ng/L］（P < 0.05）。与单支组比较，双支和多支组血清AnxA1、QTc、TP-Tec水平升高［（1.08 ± 0.15）vs（1.36 ± 0.21）vs（1.60 ± 0.25 μg/mL］ ［（439.84 ± 19.73）vs（459.73 ± 19.80）vs（479.74 ± 20.11）ms］ ［（114.82 ± 11.40）vs（121.89 ± 10.96）vs（127.41 ± 10.57） ms］，ADAMTS13水平降低［（1.05 ± 0.27）vs（0.82 ± 0.19）vs（0.61 ± 0.13）ng/L］（P < 0.05）。与轻度组比较，中度组和重度组血清AnxA1、QTc、TP-Tec水平升高［（1.11 ± 0.14）vs（1.35 ± 0.20）vs（1.55 ± 0.27）μg/mL］ ［（438.96 ± 20.37）vs（459.44 ± 21.19）vs（479.84 ± 22.42）ms］ ［（113.43 ± 11.58）vs（121.88 ±11.39）vs（128.96 ± 11.16）ms］，ADAMTS13水平降低［（1.03 ± 0.23）vs（0.88 ± 0.17）vs（0.58 ± 0.12）ng/L］（P < 0.05）。与稳定斑块组比较，不稳定斑块组血清AnxA1、QTc、TP-Tec水平升高［（1.15 ± 0.24）vs（1.46 ± 0.31）μg/mL）］ ［（440.37 ± 29.11）vs（472.29 ± 28.62） ms］ ［（112.44 ± 15.63）vs（127.98 ± 15.17）ms］，ADAMTS13水平降低［（0.97 ± 0.18）vs（0.76 ± 0.09）ng/L］，差异均有统计学意义（P < 0.05）。ROC曲线结果显示，联合心电图参数预测AMI重度冠脉病变的AUC为0.948，均显著优于单独检测指标（P < 0.05）。四者联合预测AMI斑块稳定性的AUC为0.925，均显著优于各自单独检测指标（P < 0.05）。 结论 血清AnxA1、ADAMTS13联合心电图参数对AMI患者重度冠脉病变以及斑块稳定性有较好的预测价值，可为临床诊断AMI提供参考。

Abstract

Objective Investigating the value of combined serum annexin A1 （AnxA1）， a disintegrin-like and metalloproteinase with thrombospondin type-1 domain 13 （ADAMTS13）， and electrocardiogram parameters in assessing the degree of coronary stenosis and plaque stability in patients with acute myocardial infarction （AMI）. Methods A total of 280 suspected AMI patients admitted to our hospital from August 2020 to August 2022 due to chest pain were collected as the study subjects， according to the results of coronary angiography and cTnl level， they were grouped into a non AMI group （135 cases） and an AMI group （145 cases）， the serum levels of AnxA1 and ADAMTS13 were compared between the two groups. According to the coronary Gensini score of AMI patients， they were grouped into the mild group （55 cases）， the moderate group （53 cases）， and the severe group （37 cases）. The serum levels of AnxA1 and ADAMTS13 were compared among patients with different numbers of coronary artery lesions and different degrees of coronary artery lesions. The receiver operating characteristic curve （ROC） was used to analyze the predictive value of serum AnxA1 and ADAMTS13 combined with electrocardiogram for severe coronary artery disease and plaque stability in patients with acute myocardial infarction （AMI）. Results Compared with the non AMI group， the serum AnxA1， QTc， and TP Tec levels in the AMI group were increased［（0.97 ± 0.26 ）vs （1.31 ± 0.38） μg/mL］ ［（417.56 ± 29.11 ） vs （456.88 ± 28.62） ms］ ［（106.53 ± 15.28） vs （120.48 ± 14.91） ms］， ADAMTS13 levels decreased ［（1.22 ± 0.39） vs（0.86 ± 0.29 ）ng/L］ （P < 0.05）. Compared with the single vessel group， the serum AnxA1， QTc， and TP Tec levels in the double vessel and multi vessel groups increased［（1.08 ± 0.15）vs（1.36 ± 0.21）vs（1.60 ± 0.25 μg/mL］ ［（439.84 ± 19.73）vs（459.73 ± 19.80）vs（479.74 ± 20.11）ms］ ［（114.82 ± 11.40）vs（121.89 ± 10.96）vs（127.41 ± 10.57） ms］， ADAMTS13 levels decreased［（1.05 ± 0.27）vs（0.82 ± 0.19）vs（0.61 ± 0.13）ng/L］ （P < 0.05）.Compared with the mild group， the serum AnxA1， QTc， and TP Tec levels in the moderate and severe groups increased ［（1.11 ± 0.14）vs（1.35 ± 0.20）vs（1.55 ± 0.27）μg/mL］ ［（438.96 ± 20.37）vs（459.44 ± 21.19）vs（479.84 ± 22.42）ms］ ［（113.43 ± 11.58）vs（121.88 ±11.39）vs（128.96 ± 11.16）ms］， ADAMTS13 levels decreased ［（1.03 ± 0.23）vs（0.88 ± 0.17）vs（0.58 ± 0.12）ng/L］ （P < 0.05）. Compared with the stable plaque group， the serum AnxA1， QTc， and TP Tec levels in the unstable plaque group were significantly increased［（1.15 ± 0.24）vs（1.46 ± 0.31）μg/mL）］ ［（440.37 ± 29.11）vs（472.29 ± 28.62） ms］ ［（112.44 ± 15.63）vs（127.98 ± 15.17）ms］， ADAMTS13 levels significantly decreased［（0.97 ± 0.18）vs（0.76 ± 0.09）ng/L］， with statistically significant difference （P < 0.05）. The ROC curve results showed that the AUC of combining electrocardiogram parameters to predict the degree of coronary artery disease in AMI was 0.948， which was better than individual detection （P < 0.05）. The ROC curve results showed that the combined prediction of electrocardiogram parameters for severe coronary artery disease in AMI had an AUC of 0.925， which was superior to their individual detection （P < 0.05）. Conclusion The combination of electrocardiogram and serum AnxA1， ADAMTS13 showed better predictive value for severe coronary artery disease and plaque stability in AMI， providing a reference for clinical diagnosis of AMI.

关键词

急性心肌梗死 / 膜联蛋白A1 / 血管性血友病因子裂解蛋白酶 / 心电图 / 应用价值

Key words

Acute myocardial infarction / Annexin A1 / Von Willebrand factor cleaving protease / Electrocardiogram / Application value

基金资助

河南省医学科技攻关联合共建项目(LHGJ201960251)