非ST段抬高型急性冠状动脉综合征hs-CRP、Lp(a)、CysC及ApoA与GRACE评分相关性研究

目的:探讨非ST段抬高型急性冠状动脉综合征(NSTE-ACS)病人血清高敏C反应蛋白(hs-CRP)、胱抑素C(Cys C)、载脂蛋白A(ApoA)、脂蛋白a[Lp(a)]与全球急性冠状动脉事件注册评分(GRACE评分)相关性.方法:选取130例NSTE-ACS病人(NSTE-ACS组)及同期80例非冠心病病人(对照组),入院后收集2组的临床资料,同时第2天清晨空腹采集肘静脉血检测hs-CRP、CysC、ApoA、Lp(a)水平,并进行GRACE危险评分,根据GRACE危险评分将病人分为3组,低危组≤99分,中危组>99～140 分,高危组>140分.结果:NSTE-ACS组年龄、性别、肌酐、高血压病史、糖尿病病史、hs-CRP、Lp(a)、CysC和GRACE评分值均高于对照组(P<0.05～P<0.01),ApoA显著低于对照组(P<0.01);不同GRACE评分病人冠状动脉病变支数构成差异无统计学意义(P>0.05),而3组冠状动脉狭窄程度构成差异有统计学意义(P<0.05);中危组和高危组病人血浆hs-CRP和Lp(a)水平均明显高于低危组(P<0.01),而血浆ApoA水平均明显低于低危组(P<0.01).高危组血浆Lp(a)和CysC水平均明显高于中危组(P<0.01),ApoA水平显著低于中危组(P<0.01),且血清CysC水平明显高于低危组(P<0.01);不同冠状动脉病变支数及不同冠状动脉狭窄程度病人血浆hs-CRP、Apo A、Lp(a)和CysC差异均有统计学意义(P<0.01),其中3支病变、重度狭窄或闭塞hs-CRP、Lp(a)、CysC最高,ApoA最低;单支病变、轻度狭窄hs-CRP、Lp(a)、CysC最低,ApoA最高.结论:hs-CRP、CysC、Lp(a)、ApoA与GRACE评分密切相关,联合检测对早期危险分层、预后评估及诊疗方案的选择重要参考价值.

Relationship between the levels of hs-CRP,CysC,ApoA,Lp(a) and GRACE score in NEST-ACS patients

Objective:To investigate the correlations between serum high-sensitivity C-reactive protein(hs-CRP),Cystatin C(CysC),apolipoprotein A(ApoA),lipoprotein(a)[Lp(a)] and global registry of acute coronary evects(GRACE)score in non ST-elevation acute coronary syndromes(NSTE-ACS)patients.Methods:One hundred and thirty patients with NSTE-ACS and 80 patients without NSTE-ACS were divided into the NSTE-ACS group and control group,respectively.The clinical data of patients were collected,the serum levels of hs-CRP,CysC,ApoA and Lp(a)were detected on the second day of admission,and the GRACE score was assessed.The NSTE-ACS patients were subdivided into the low risk group(GRACE score≤99),middle risk group(140≥GRACE score>99)and high risk group(GRACE score>140)according to the GRACE risk score.Results:The age,gender,creatinine,history of hypertension and diabetes,hs-CRP,Lp(a),CysC and GRACE score in NSTE-ACS group were higher than those in control group(P<0.05 to P<0.01),while the level of ApoA in NSTE-ACS group was significantly lower than that in control group(P<0.01).The differences of the coronary artery lesion between three groups were not statistically significant(P>0.05),while the differences of the coronary artery stenosis degree between three groups were statistically significant(P<0.05).The serum levels of hs-CRP and Lp(a)in middle risk group and high risk group were significantly higher than those in low risk group(P<0.01),but the serum levels of ApoA in middle risk group and high risk group were significantly lower than those in low risk group(P<0.01).The serum levels of Lp(a)and CysC in high risk group were significantly higher than those in middle risk group(P<0.01),the serum level of ApoA in high risk group was significantly lower than that in middle risk group(P<0.01),and the serum level of CysC in high risk group was significantly higherthan that in low risk group(P<0.01).The differences of the levels of hs-CRP,ApoA,Lp(a)and CysC in different coronary artery lesions and stenosis degrees were statistically significant(P<0.01).In three-vessel coronary artery lesions and severe stenosis or occlusion of coronary artery patients,the levels of hs-CRP,Lp(a)and CysC were the highest,and the level of ApoA was the lowest.In single-vessel coronary artery lesion and mild stenosis of coronary artery patients,the levels of hs-CRP,Lp(a)and CysC were the lowest,and the level of ApoA was the highest.Conclusions:The levels of hs-CRP,CysC,Lp(a)and ApoA are closely related to the GRACE score.The joint detection has important clinical reference values in the early risk stratification,prognosis assessment and diagnosis scheme.