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目的探讨血清抵抗素水平在冠心病患者中的诊断价值。方法采用病例-对照研究,48例冠心病患者入院时测定血清抵抗素水平,观察24个月时发生不良心血管事件(心原性死亡、非致死性心肌梗死)的情况。Cox比例风险回归分析血清抵抗素水平对研究对象的预后影响,应用受试者工作特征曲线(ROC曲线)确定抵抗素水平界值,根据该值将患者危险分层,分为高危组和低危组。结果冠心病患者血清抵抗素水平较对照组明显升高[(96±23)vs(16±5)μg/L,P<0.001],而且不同临床类型的冠心病患者间差异显著(均P<0.01);Cox比例风险回归分析显示,血清抵抗素(RR1.216,95%CI:1.203～1.229)和糖尿病(RR2.083,95%CI:1.301～3.334)对估测预后有价值;ROC曲线确定血清抵抗素水平危险分层的最佳界值取93μg/L,其敏感性75%,特异性81.8%,高危组中发生不良心血管事件3例(27.3%),而无事件者为8例(72.7%);低危组中依次分别为1例(8.3%)和36例(91.7%),高危组预后情况较低危组更差(27.3%vs8.3%,P=0.033;RR13.5,95%CI:1.238～147.232)。结论根据血清抵抗素水平可评估冠心病患者的预后,而对其危险分层的最佳界值取值93μg/L可能是较有意义的生化指标。
Objective To investigate the diagnostic value of serum resistin in patients with coronary heart disease. Methods A case-control study was conducted. Serum resistin level was measured in 48 patients with coronary heart disease admitted to hospital. Adverse cardiovascular events (cardiogenic death and non-fatal myocardial infarction) were observed at 24 months. Cox proportional hazards regression analysis of the impact of serum resistin on the prognosis of the study subjects, application of receiver operating characteristic curve (ROC curve) to determine the level of resistin threshold, based on the value of the risk stratification, divided into high-risk group and low risk group. Results The level of serum resistin in patients with coronary heart disease was significantly higher than that in the control group [(96 ± 23) vs (16 ± 5) μg / L, P <0.001], and there was significant difference between patients with different clinical types of coronary heart disease (all P < 0.01). Cox proportional hazards regression analysis showed that serum resistin (RR1.216, 95% CI: 1.203-1.229) and diabetes (RR2.083, 95% CI: 1.301-3.354) The optimal cut-off value of serum resistin level was 93 μg / L, with a sensitivity of 75% and a specificity of 81.8%. Three patients (27.3%) had adverse cardiovascular events in the high-risk group and 8 (72.7%) in the low-risk group, followed by 1 case (8.3%) and 36 cases (91.7%) in the low-risk group, and worse in the high risk group (27.3% vs 8.3%, P = .5, 95% CI: 1.238 ~ 147.232). Conclusions The prognosis of patients with coronary heart disease can be evaluated according to the level of serum resistin. However, the best cut-off value of 93μg / L for risk stratification may be a more significant biochemical index.