磷酸二酯酶-9A对评估冠状动脉粥样硬化病变程度的临床价值

目的:探讨血浆磷酸二酯酶-9A(PDE-9A)水平与冠状动脉(冠脉)粥样硬化病变严重程度的关系。方法:选择经冠脉造影确诊的冠状动脉粥样硬化性心脏病(冠心病)75例(单支病变33例、二支病变22例、三支病变20例)和同期行冠脉造影无血管病变的对照组25例,应用ELISA法测定血浆PDE-9A水平。以冠脉病变血管支数及Gensini积分评估冠脉粥样硬化程度,并与血浆PDE-9A水平进行相关分析。应用ROC曲线评估PDE-9A对严重冠脉病变的预测价值。结果:冠心病组血浆PDE-9A水平明显高于对照组[(29.50±7.77)ng/mL对(15.35±3.25)ng/mL,P0.05)]。随冠脉病变血管支数增多,血浆PDE-9A水平也逐渐升高(P0.05)。血浆PDE-9A水平与Gensini冠脉病变积分呈正相关(r=0.319,P0.05)。ROC曲线分析结果显示,血浆PDE-9A24.73 ng/mL预测多支(二支和三支)血管病变的敏感性为78.6%,特异性为92.3%;预测严重冠脉粥样硬化(Gensini积分≥45)的敏感性为93.2%,特异性为94.8%。但logistic多因素回归分析提示,血浆PDE-9A水平不是冠脉病变的独立危险因素。结论:血浆PDE-9A水平对评估冠脉病变严重性具有一定的临床价值。

Clinical value of phosphodiesterase-9A in evaluation of the degree of coronary atherosclerosis

Objective:To assess the relationship between the level of phosphodiesterase-9A (PDE-9A) and the degree of coronary atherosclerosis.Methods:Plasma levels of PDE-9A were measured by enzyme linked immune sorbent assay (ELISA) in 75 patients with coronary artery disease which was identified by coronary angiography (single-vessel disease in 33, two-vessel in 22 and three-vessel in 20) and 25 control subjects who were negative in coronary angiography.The degree of coronary atherosclerosis was expressed by number of significant coronary lesion and Gensini coronary score.Correlation between PDE-9A levels and the severity of coronary lesions was tested.ROC curve analysis were performed to determine the diagnostic value of plasma PDE-9A for severe coronary artery disease.Results:The plasma PDE-9A levels were significantly higher in patients with coronary artery disease than those in control subjects [(29.50±7.77) ng/mL vs.(15.35±3.25) ng/mL, P<0.05)], and increased stepwise from single-to three-vessel disease patients (P<0.05).Plasma levels of PDE-9A correlated positively with Gensini coronary score (r=0.319, P<0.05).ROC curve analysis showed that a plasma PDE-9A level of 24.73 ng/mL was an optimal cut-off for detecting the presence of multi-vessel coronary artery diseases (sensitivity 78.6%, specificity 92.3%) and severe vascular lesions (Gensini scores≥45) (sensitivity 93.2%, specificity 94.8%).However, multifactor logistic regression model indicated that plasma PDE-9A was not an independent risk factor for coronary artery disease.Conclusion:Plasma levels of PDE-9A may reflect the degree of coronary atherosclerosis and could be useful for evaluating the presence and severity of coronary artery disease.