摘要
目的:探讨心脏超声造影联合血清血小板反应蛋白解整合素金属肽酶-4(ADAMTS-4)、骨保护素(OPG)评估冠心病病人冠状动脉病变程度的临床价值.方法:选取 2019年 10月—2022年 10月四川绵阳四 0四医院收治的 90例冠心病病人作为研究对象,根据 Gensini评分将病人分为重度病变组(30例)、中度病变组(28例)、轻度病变组(32 例),均行心脏超声造影检查及血清ADAMTS-4、OPG检测.比较 3组心脏超声造影定量参数(A值、β值)及血清 ADAMTS-4、OPG检测值;采用 Pearson相关性分析心脏超声造影定量参数及血清ADAMTS-4、OPG水平与Gensini评分的相关性;采用受试者工作特征(ROC)曲线评估心脏超声造影定量参数及血清ADAMTS-4、OPG水平对重度冠状动脉病变的评估效能.结果:中度病变组、重度病变组心脏超声造影定量参数A值、β值低于轻度病变组,血清 ADAMTS-4、OPG水平高于轻度病变组,差异均有统计学意义(P<0.05);重度病变组心脏超声造影定量参数 A值、β值低于中度病变组,血清 ADAMTS-4、OPG水平高于中度病变组,差异均有统计学意义(P<0.05).Pearson相关性分析显示,心脏超声造影 A值、β值与 Gensini 评分均呈负相关(P<0.05),血清 ADAMTS-4、OPG 水平与 Gensini 评分均呈正相关(P<0.05).ROC曲线显示,A值、β值及血清 ADAMTS-4、OPG单独诊断重度冠状动脉病变的最佳截断值分别为 3.38、0.30、107.57 ng/mL、0.20 ng/mL,对应的曲线下面积(AUC)分别为 0.797,0.883,0.895,0.680,4 项指标联合诊断的 AUC为 0.937.结论:心脏超声造影定量参数 A值、β值及血清 ADAMTS-4、OPG与冠心病病人冠状动脉病变程度存在相关性,联合检测在重度冠状动脉病变的评估中具有较高的应用价值.
Abstract
Objective:To explore the clinical value of contrast-enhanced echocardiography combined with serum disintegrin-like and metalloproteinase with thrombospondin motifs-4(ADAMTS-4)and osteoprotegerin(OPG)for evaluating the degree of coronary artery lesion in patients with coronary heart disease.Methods:A total of 90 patients with coronary heart disease were enrolled as the study subjects.According to Gensini score,the patients were divided into coronary artery evere lesion group(30 cases),moderate lesion group(28 cases),and mild lesion group(32 cases).Contrast-enhanced echocardiography,serum ADAMTS-4 and OPG were detected in all patients.Quantitative parameters of contrast-enhanced echocardiography ultrasound(A value,βvalue),serum ADAMTS-4 and OPG values were compared among the 3 groups.Pearson correlation analysis was used to analyze the correlation between quantitative parameters of contrast-enhanced echocardiography,serum ADAMTS-4 and OPG levels,and Gensini score.Receiver operating characteristic curve(ROC)was drawn to assess the efficacy of quantitative parameters of contrast-enhanced echocardiography and serum ADAMTS-4 and OPG levels on severe coronary artery lesion.Results:The quantitative parameters A andβvalues of contrast-enhanced ultrasound in moderate lesion group and evere lesion group were lower than those in mild lesion group,and serum ADAMTS-4 and OPG levels were higher than those in mild lesion group,with statistical significance(P<0.05).The quantitative parameters A andβvalues of contrast-enhanced ultrasound in evere lesion group were lower than those in moderate lesion group,and serum ADAMTS-4 and OPG levels were higher than those in moderate lesion group,with statistical significance(P<0.05).Pearson correlation analysis showed that the A value and β value of contrast-enhanced echocardiography were negatively correlated with Gensini score(P<0.05),and the levels of serum ADAMTS-4 and OPG were positively correlated with Gensini score(P<0.05).ROC curve showed that the optimal cut-off values of A value,βvalue,serum ADAMTS-4,and OPG alone in the diagnosis of severe coronary artery lesion were 3.38,0.30,107.57 ng/mL,and 0.20 ng/mL,respectively.The corresponding areas under the curve(AUC)were 0.797,0.883,0.895,and 0.680,respectively.The combined diagnosis AUC of the four indexes was 0.937.Conclusion:The contrast-enhanced echocardiography quantitative parameters of A value,βvalue,ADAMTS-4,and OPG are correlated with the degree of coronary artery lesion in patients with coronary heart disease,and the combined detection shows a high application value for the evaluation of severe degree of coronary artery lesion.
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