南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (09): 1253-1258.doi: 10.12122/j.issn.1673-4254.2020.09.05

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急性冠脉综合征患者血浆N-乙酰-神经氨酸水平和TIMI危险分层及临床预后之间的相关性

李妙男，钱少环，姚卓亚，闵生萍，史晓俊，康品方，张宁汝，王效静，高大胜，高 琴，张 恒，王洪巨   

  • 出版日期:2020-09-20 发布日期:2020-09-20

Correlation of plasma N-acetyl-neuraminic acid level with TIMI risk stratification and clinical outcomes in patients with acute coronary syndrome

  • Online:2020-09-20 Published:2020-09-20

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摘要： 目的 探讨急性冠脉综合征（ACS）患者血浆N-乙酰-神经氨酸水平与心肌梗死溶栓治疗临床试验危险评分（TIMI危险评分）和临床预后之间的相关性。方法 该研究为前瞻性单中心观察性研究，连续纳入2018年10月~2019年7月在我院拟行冠状动脉造影检查的患者708例。收集所有患者的一般临床资料、实验室检查结果、影像学资料和介入治疗资料。根据病史和检查结果分为：ACS组（597例）和对照组（111例）。根据TIMI危险评分对ACS组患者进一步分为高危组（104例）、中危组（425例）和低危组（68例）。采用液相色谱串联质谱法检测患者的血浆Neu5Ac水平；所有患者均行冠状动脉造影检查，计算血管病变支数和Gensini评分。设计调查表，出院后对ACS组患者通过电话或门诊随访平均15个月，统计Mace事件的发生，根据Mace事件将ACS组患者分为Mace组（80例）和非Mace组（517例）。结果 ACS组患者血浆Neu5Ac水平明显高于对照组（P<0.05），ROC曲线显示血浆Neu5Ac水平可以辅助ACS诊断[0.648（0.597~0.699）]，敏感性为39.2%，特异性为86.5%，其临界值为288.50 ng/mL。TIMI危险分层显示，高危组患者血浆Neu5Ac水平明显高于中危组和低危组患者（P<0.05），ROC曲线显示血浆Neu5Ac水平可以协助高危组患者诊断[0.645（0.588~0.703）]，敏感性为42.3%，特异性为80.1%，其临界值为327.50 ng/mL。相关性分析显示：血浆Neu5Ac与年龄、血尿酸、肌酐、脂蛋白a、D-二聚体、C反应蛋白、肌酸激酶同工酶和Gensin评分成正相关性报告P值，与高密度脂蛋白水平成负相关性报告P值。对ACS组患者随访平均15个月后，发现Mace事件组的患者血浆Neu5Ac水平明显高于非Mace事件组的患者。二元Logistic回归显示，血浆Neu5Ac水平、既往脑卒中病史是Mace事件发生的独立危险因素。结论 血浆Neu5Ac水平对ACS的诊断和危险分层具有参考价值，是ACS患者临床预后的独立危险因素。

关键词: 急性冠脉综合征, 血浆N-乙酰-神经氨酸, TIMI危险评分, 临床预后

Abstract: Objective To explore the correlation of plasma N-acetyl-neuraminic acid level with Thrombolysis In Myocardial Infarction (TIMI) risk score and clinical outcomes of patients with acute coronary syndrome (ACS). Methods We consecutively enrolled 708 consecutive patients (401 male and 307 female, mean age 63.6±10.6 years) undergoing coronary angiography in our hospital between October, 2018 and July, 2019, including 597 patients with ACS and 111 without ACS (control group). The patients with ACS group were divided into high (n=104), moderate (n=425) and low (n=68) risk groups according to their TIMI risk scores. All the participants were examined for plasma Neu5Ac level using liquid chromatography-tandem mass spectrometry and underwent coronary angiography with their Gensini scores calculated. The patients with ACS were followed up after discharge for a mean of 15 months for the occurrence of major adverse cardiac events (Mace). Binary logistic regression analysis was performed to identify the risk factors of Mace in these patients. Results Plasma Neu5Ac levels were significantly higher in ACS group than in the control group (P<0.05). ROC curve analysis showed that plasma Neu5Ac level could assist in the diagnosis of ACS (0.648 [0.597-0.699]) with a sensitivity of 39.2% and a specificity of 86.5% at the cutoff value of 288.50 ng/mL. In the ACS patients, plasma Neu5Ac level was significantly higher in the high-risk group than in the moderate-risk and low-risk groups (P<0.05) and could assist in the diagnosis of a high risk (0.645 [0.588-0.703]) with a sensitivity of 42.3% and a specificity of 80.1% at the cutoff value of 327.50 ng/ mL. Plasma Neu5Ac was positively correlated with age, serum uric acid, creatinine, lipoprotein a, Ddimer, C-reactive protein, MB isoform of creatine kinase and Gensini score and negatively correlated with high-density lipoprotein level. During the followup, 80 ACS patients experienced Mace, who had significantly higher plasma Neu5Ac level than those without Mace (n=517). Logistic regression analysis showed that plasma Neu5Ac level and a history of previous stroke were independent risk factors for the occurrence of Mace. Conclusion Plasma Neu5Ac level can provide assistance in the diagnosis and risk stratification of ACS and is an independent risk factor for prognosis of ACS patients.

Key words: acute coronary syndrome, plasma N-acetyl-neuraminic acid, Thrombolysis In Myocardial Infarction risk score; prognosis