Clinical value of CT angiography combined with serum homocysteine, lipoprotein (a) and B-type natriuretic peptide in evaluating coronary atherosclerosis stenosis
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摘要:
目的 探讨CT血管造影联合血清同型半胱氨酸（Hcy）、脂蛋白（LP）(a) 及B型脑钠肽（BNP）在冠状动脉硬化狭窄中的评估价值。 方法 选取我院2020年12月~2021年7月收治的150例冠心病患者作为观察组，另选取86例健康体检者作为对照组，均予以CT血管造影及血清Hcy、BNP、LP(a)水平检查，分析上述血清指标与疾病类型、冠脉病变支数、冠脉狭窄程度、斑块性质及CT血管造影冠脉参数的相关性。 结果 观察组血清Hcy、BNP、LP(a)水平及斑块负荷、血管狭窄程度、重建指数（RI）较对照组更高，血管体积低于对照组（P < 0.05）；急性心肌梗死患者血清Hcy、LP(a)、BNP水平及斑块负荷均 > 不稳定型心绞痛患者 > 稳定型心绞痛患者 > 隐匿型冠心病患者（P < 0.05）；随冠脉病变支数、冠脉狭窄程度增加，冠心病患者上述血清指标升高，斑块负荷、RI值均增加（P < 0.05）；非钙化斑块者上述血清指标及斑块负荷、血管狭窄程度、RI值高于钙化斑块者（P < 0.05）；冠心病患者3项血清指标均与非钙化斑块及斑块负荷、急性心肌梗死、冠脉病变支数、冠脉狭窄程度、血管狭窄程度、RI值呈正相关（P < 0.05）；ROC曲线显示，CT血管造影联合3项血清指标诊断冠状动脉硬化重度狭窄（狭窄程度 > 75%）的敏感度、特异性、曲线下面积分别为0.81、0.82、0.878。 结论 冠心病患者血清Hcy、LP(a)、BNP水平逐渐升高，与CT血管造影参数联合可较好地诊断冠状动脉硬化狭窄程度。 Abstract:Objective To explore the value of CT angiography (CTA) combined with serum homocysteine (Hcy), lipoprotein (a)[LP(a)] and B-type natriuretic peptide (BNP) in evaluating coronary atherosclerosis stenosis. Methods A total of 150 patients with coronary heart disease admitted to the hospital between December 2020 and July 2021 were selected as the observation group. Meanwhile, 86 healthy individuals were selected as the control group. All patients were performed with CTA and detection of serum Hcy, BNP and LP(a) levels. The correlations of above- mentioned serum indicators with disease type, number of affected coronary arteries, coronary artery stenosis degree, character of plaque and CTA parameters were analyzed. Results Serum Hcy, BNP and LP(a) levels, plaque burden, vascular artery stenosis degree, and reconstruction index (RI) in the observation group were higher than those in the control group, while blood vessel volume was smaller than that in the control group (P < 0.05). Serum Hcy, LP(a) and BNP levels, and plaque burden decreased in sequence from patients with acute myocardial infarction, patients with unstable angina pectoris, patients with stable angina pectoris, to patients with latent coronary heart disease (P < 0.05). As affected coronary artery increased and coronary artery stenosis aggravated, the levels of serum indicators, plaque burden and RI in patients with coronary heart disease increased (P < 0.05). The levels of serum indicators, plaque burden, vascular stenosis degree and RI in patients with noncalcified plaques were higher than those in patients with calcified plaques (P < 0.05). The levels of serum indicators in patients with coronary heart disease were positively correlated with acute myocardial infarction, the number of affected coronary arteries, coronary artery stenosis degree, non-calcified plaque, plaque burden, vascular stenosis degree, and RI (P < 0.05). ROC curve showed that the sensitivity, specificity and area under the curve of CTA combined with the three serum indicators to diagnose severe coronary atherosclerosis stenosis (stenosis > 75%) were 0.81, 0.82 and 0.878, respectively. Conclusion Serum Hcy, LP(a) and BNP levels are increased in patients with coronary heart disease. The combined use of CTA parameters can better diagnose the degree of coronary atherosclerosis stenosis. -
图 1 CTA联合血清Hcy、LP(a)、BNP诊断冠状动脉硬化重度狭窄的ROC曲线
Figure 1. ROC curve of CTA combined with serum Hcy, LP(a) and BNP to diagnose severe coronary artery stenosis.
图 2 典型病例
CTA显示, 左右冠状动脉均衡型, 左右冠状动脉起源无异常（A）; 未见左右冠状动脉走形异常, 左冠状动脉前降支中段及回旋支起始形成非钙化斑块, 对应管腔轻度变窄（B）; 右冠状动脉、左冠状动脉主干显示清晰, 管腔内未见确切狭窄与异常密度影, 心脏附属结构及肺部无确切异常征象（C）.
Figure 2. Images of a classic case.
表 1 两组血清Hcy、LP(a)、BNP及CTA参数对比
Table 1. Comparison of serum Hcy, LP(a), BNP and CTA parameters between the two groups (Mean±SD)
组别 Hcy（ng/mL） LP(a)（mg/L） BNP（pg/mL） 血管体积（mm3） 斑块负荷（%） 血管狭窄程度（%） RI 观察组（n=150） 1.67±0.17 312.86±32.45 178.42±18.59 548.22±55.19 64.51±6.47 61.14±6.23 1.61±0.18 对照组（n=86） 1.23±0.14 268.94±27.13 35.41±3.67 596.71±60.06 58.72±5.89 57.18±5.76 1.42±0.16 t 20.363 10.603 70.496 6.289 6.832 4.828 8.120 P < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 Hcy: 同型半胱氨酸; LP(a): 脂蛋白(a); BNP: B型脑钠肽; RI: 重建指数. 
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表 2 不同疾病类型的冠心病患者血清Hcy、LP(a)、BNP、CTA冠脉参数比较
Table 2. Comparison of serum Hcy, LP(a), BNP and CTA parameters between patients with different types of coronary heart diseases (Mean±SD)
组别 Hcy（ng/mL） LP(a)（mg/L） BNP（pg/mL） 血管体积（mm3） 斑块负荷（%） 血管狭窄程度（%） RI AMI（n=51） 1.80±0.19 340.28±34.81 191.21±19.35 546.77±55.13 69.73±6.89 62.17±6.24 1.60±0.16 UAP（n=38） 1.71±0.18* 316.22±32.16* 180.17±18.24* 549.26±55.07 66.15±6.57* 62.22±6.27 1.63±0.17 SAP（n=34） 1.62±0.17*# 296.39±30.08*# 170.12±17.26*# 550.86±55.69 60.18±6.25*# 60.05±6.15 1.63±0.16 隐匿型冠心病（n=27） 1.45±0.15*#▲ 277.11±27.89*#▲ 162.26±16.37*# 546.17±54.87 57.79±5.94*# 59.06±5.98 1.58±0.15 F 24.778 26.959 18.165 0.055 26.382 2.230 0.748 P < 0.001 < 0.001 < 0.001 0.983 < 0.001 0.087 0.525 *P < 0.05 vs AMI; #P < 0.05 vs UAP; ▲P < 0.05 vs SAP. AMI：急性心肌梗死; UAP: 不稳定型心绞痛; SAP: 稳定型心绞痛.
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表 3 不同冠脉病变支数、狭窄程度、斑块性质患者各指标比较
Table 3. Comparison of indicators between patients with different numbers of coronary artery lesions, patients with different degrees of stenosis, and patients with different plaques (Mean±SD)
类型组别 Hcy（ng/mL） LP(a)（mg/L） BNP（pg/mL） 血管体积（mm3） 斑块负荷（%） 血管狭窄程度（%） RI 冠脉病变支数 单支（n=58） 1.55±0.16 290.82±30.06 167.38±16.84 546.35±54.89 60.23±6.15 60.62±6.15 1.56±0.15 双支（n=63） 1.68±0.17 312.85±31.82 180.31±18.15 548.43±54.82 65.36±6.58 61.47±6.16 1.63±0.16 多支（n=29） 1.89±0.19 356.98±36.44 196.39±19.85 551.52±56.63 71.24±7.18 61.45±6.15 1.68±0.17 F 38.719 41.066 25.712 0.086 28.324 0.334 6.219 P < 0.001 < 0.001 < 0.001 0.918 < 0.001 0.716 0.003 冠脉狭窄程度 轻度（n=62） 1.56±0.15 296.59±30.15 171.15±17.24 549.16±55.03 61.82±6.21 61.09±6.15 1.48±0.15 中度（n=56） 1.66±0.16 310.56±31.67 178.95±18.03 547.23±54.85 64.55±6.48 61.18±6.12 1.65±0.17 重度（n=32） 1.89±0.19 348.42±35.14 191.58±19.62 548.13±54.96 69.66±7.05 61.17±6.14 1.78±0.18 F 43.423 28.223 13.544 0.018 15.374 0.004 38.196 P < 0.001 < 0.001 < 0.001 0.982 < 0.001 0.996 < 0.001 斑块性质 钙化斑块（n=64） 1.59±0.16 303.47±30.74 173.85±17.62 547.21±54.81 60.89±6.11 59.81±6.02 1.52±0.15 非钙化斑块（n=86） 1.73±0.18 319.85±31.93 181.83±18.96 548.98±54.96 67.21±6.75 62.14±6.25 1.68±0.17 t 4.937 3.157 2.627 0.195 5.903 2.294 5.990 P < 0.001 0.002 0.009 0.845 < 0.001 0.023 < 0.001
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表 4 相关性分析结果
Table 4. Correlation analysis results
指标 非钙化斑块 AMI 冠脉病变支数 冠脉狭窄程度 斑块负荷 血管狭窄程度 RI Hcy 0.618 0.482 0.537 0.422 0.579 0.487 0.359 LP(a) 0.475 0.513 0.322 0.418 0.527 0.514 0.368 BNP 0.459 0.477 0.405 0.422 0.513 0.487 0.426
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表 5 CTA联合血清Hcy、LP(a)、BNP诊断冠状动脉硬化重度狭窄的价值
Table 5. The value of CTA combined with serum Hcy, LP(a) and BNP in the diagnosis of severe coronary artery stenosis
指标 曲线下面积 95% CI 敏感度 特异性 CTA 0.830 0.776~0.885 0.78 0.76 Hcy 0.799 0.735~0.863 0.77 0.65 LP(a) 0.831 0.777~0.884 0.77 0.79 BNP 0.796 0.735~0.856 0.75 0.68 CTA联合血清Hcy、LP(a)、BNP 0.878 0.830~0.926 0.81 0.82
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