Changes and significance of red blood cell distribution width, blood uric acid, D-Dimer and B-ype natriuretic peptide in acute coronary syndrome
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摘要:
目的 研究红细胞分布宽度(RDW)、血尿酸(BUA)、D-二聚体(D-Dimer)和B型利钠肽(BNP)水平在急性冠脉综合征(ACS)中的意义。 方法 收集2017年1月—2019年3月因ACS在蚌埠市第三人民医院住院行冠脉造影的171例患者为试验组，取同期冠脉造影或冠脉CT无明显异常患者65例为对照组，比较2组RDW、BUA、D-二聚体和BNP。试验组采用Gensini评分分组，分析各组4项指标；按患者住院期间的心血管不良事件发生情况(MACE)分组，分析各组4项指标。采用logistic回归分析研究4项指标与ACS的关系。 结果 试验组RDW、BUA、D-二聚体和BNP水平均高于对照组(均P＜0.01)；不同Gensini评分各组RDW、D-二聚体和BNP差异均有统计学意义(均P＜0.01)；不同MACE组内4项指标差异有统计学意义(均P＜0.01)。Logistic回归分析示4项指标均与ACS相关，灵敏度分别为0.468、0.544、0.655、0.404，特异度为0.738、0.662、0.708、0.754，AUC为0.610、0.617、0.670、0.584，4项指标组成联合因子灵敏度为0.731，特异度为0.631，AUC为0.714。 结论 RDW、BUA、D-二聚体和BNP与ACS患者病情相关，4项指标联合检测在ACS诊断中有临床意义。 Abstract:Objective To study the significance of red blood cell distribution width (RDW), blood uric acid (BUA), D-Dimer and B-type natriuretic peptide (BNP) levels in acute coronary syndrome (ACS). Methods Total 171 patients with ACS who underwent coronary angiography in the Third People's Hospital of Bengbu City from January 2017 to March 2019 were collected as experimental group, and 65 patients with no obvious abnormalities in coronary angiography or coronary CT during the same period were selected as controls group. The RDW, BUA, D-Dimer and BNP of the two groups were compared. The experimental group was divided into groups by Gensini score, and 4 indicators of each group were analyzed. The patients were grouped according to the adverse cardiovascular events (MACE) during hospitalization, and 4 indicators in each group were analyzed. Logistic regression was used to analyze the relationship between 4 indicators and ACS. Results The levels of RDW, BUA, D-Dimer and BNP in the experimental group were higher than those in the control group (all P < 0.01). Gensini scores were different in each group in RDW, D-Dimer and BNP (all P < 0.01). There were differences in 4 indicators in the MACE group (all P < 0.01). Logistic regression analysis showed that the 4 indicators were all related to ACS, the sensitivity were 0.468, 0.544, 0.655 and 0.404, the specificity were 0.738, 0.662, 0.708 and 0.754, and the area under the curve (AUC) were 0.610, 0.617, 0.670 and 0.584, respectively. The sensitivity of the combination factor composed of four indicators was 0.731, the specificity was 0.631, and the AUC was 0.714. Conclusion RDW, BUA, D-Dimer and BNP are related to the condition of ACS patients. The combined detection of 4 indicators has clinical significance in ACS. -
图 1 BUA、D-二聚体、BNP和RDW及四者联合预测ACS的ROC曲线
Figure 1. The ROC curves of BUA, D- dimer, BNP, RDW and their combined prediction of ACS
表 1 Gensini评分方法
Table 1. Gensini scoring method
狭窄程度 评分 病变部位 评分 1%~25% 1 左主干 5.0 26%~50% 2 左前降支或回旋支近端 2.5 51%~75% 4 左前降支中段 1.5 76%~90% 8 左前降支远端左回旋支中/远端 1.0 91%~99% 16 右冠状动脉 1.0 全闭 32 小分支 0.5 
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表 2 2组患者基本资料比较
Table 2. The basic data of the two groups were compared
组别 例数 性别(男/女，例) 年龄(x±s，岁) BMI (x±s) Hb (x±s，g/L) TC (x±s，mmol/L) LDL-C (x±s，mmol/L) FPG (x±s，mmol/L) SCr (x±s，μmol/L) 试验组 171 92/79 56.63±10.38 24.58±3.21 129.11±18.01 2.48±0.91 3.05±1.08 8.63±2.39 85.27±25.40 对照组 65 35/30 54.68±10.54 24.63±3.10 132.94±15.04 2.72±0.79 2.88±1.00 8.35±2.14 80.85±24.44 统计量 < 0.001a 1.283b -0.112b -1.523b -1.871b 1.183b 0.802b 1.207b P值 0.995 0.201 0.911 0.129 0.063 0.238 0.423 0.228 注：a为χ2值，b为t值。
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表 3 不同诊断类型ACS患者既往用药及合并相关疾病情况比较(例)
Table 3. Comparison of previous drug use and related diseases in patients with different diagnosis types of ACS (cases)
诊断类型 例数 高血压 糖尿病 高脂血症 曾服用抗血小板药物 曾服用他汀类药物 UAP 72 40 51 37 45 41 STEMI 56 30 41 35 40 33 NSTEMI 43 25 33 24 28 26 χ2值 0.206 0.479 1.582 1.144 0.144 P值 0.902 0.787 0.453 0.564 0.930
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表 4 2组RDW、BUA、D-二聚体和BNP水平的比较(x±s)
Table 4. The levels of RDW, BUA, D- dimer and BNP in two groups(x±s)
组别 例数 RDW (%) BUA (μmol/L) D-二聚体(mg/L) BNP (ng/L) 对照组 65 26.13±7.19 298.22±63.14 0.21±0.05 74.01±14.83 试验组 171 34.36±8.72 327.70±54.41 0.27±0.08 194.37±96.28 t值 6.786 3.554 7.723 15.808 P值 < 0.001 < 0.001 < 0.001 < 0.001
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表 5 不同Gensini评分组ACS患者RDW、BUA、D-二聚体和BNP水平比较(x±s)
Table 5. The levels of RDW, BUA, D- dimer and BNP in ACS patients with different Gensini scores(x±s)
组别 例数 RDW(%) BUA(μmol/L) D-二聚体(mg/L) BNP(ng/L) 轻度 62 30.12±7.50 316.63±45.25 0.22±0.06 139.10±39.26 中度 59 34.47±8.03 336.06±61.15 0.27±0.05 146.62±46.27 重度 37 38.23±5.76 331.17±60.33 0.33±0.07 303.24±66.12 极重度 13 43.14±12.47 332.77±38.61 0.38±0.05 364.87±70.60 F值 14.522 1.418 44.247 145.808 P值 < 0.001 0.239 < 0.001 < 0.001
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表 6 不同MACE发生情况组ACS患者RDW、BUA和D-二聚体水平比较(x±s)
Table 6. Levels of RDW, BUA and D- dimer in ACS patients with different levels of MACE
不良事件 例数 RDW (%) BUA (μmol/L) D-二聚体(mg/L) BNP (ng/L) 心力衰竭 15 35.63±6.33 309.54±46.79 0.31±0.04 207.91±12.46 再发心绞痛 21 37.45±4.74 330.15±33.13 0.36±0.06 263.29±17.88 再发心肌梗死 8 42.54±10.43 343.64±43.68 0.47±0.10 305.06±8.48 心源性死亡 7 45.55±6.65 359.53±36.84 0.56±0.04 366.77±19.13 F值 4.770 2.933 34.613 186.05 P值 0.006 0.043 < 0.001 < 0.001
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表 7 不同指标对ACS诊断的logistic回归分析
Table 7. Logistic regression analysis of different indexes for ACS diagnosis
项目 B SE Wald χ2 P值 OR(95% CI) BUA(μmol/L) 0.030 0.010 8.337 0.004 1.030(1.010~1.051) D-二聚体(mg/L) 0.033 0.013 7.053 0.008 1.034(1.009~1.060) BNP(ng/L) 0.048 0.019 6.023 0.014 1.049(1.010~1.089) RDW(%) 0.027 0.013 3.998 0.046 1.027(1.001~1.054)
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表 8 各指标及四者联合对ACS的诊断价值
Table 8. The diagnostic value of each index and their combination in ACS
项目 AUC 最佳界值 灵敏度 特异度 截断值 BUA(μmol/L) 0.610 0.206 0.468 0.738 179.827 D-二聚体(mg/L) 0.617 0.205 0.544 0.662 0.250 BNP(ng/L) 0.670 0.363 0.655 0.708 100.343 RDW 0.584 0.157 0.404 0.754 32.342 联合因子(%) 0.714 0.362 0.731 0.631
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