CAJ | 학술논문

目的：探讨急性冠脉综合征(Acute coronary syndrome，ACS)患者监测小动脉弹性指数(C2)水平的临床价值。方法前瞻性、连续性纳入我院心血管内科于2011年1月至2013年7月期间所收治新发病的ACS患者，并以同样方式纳入同期入院的稳定型心绞痛(Stable angina, SA)患者作为对照组。收集两组患者的临床资料，比较各项危险因素之间的差异性，采用多因素Logistic模型建立回归分析，进一步筛查其中独立、敏感的影响指标。经由一元线性回归分析测定各项敏感指标与C2水平之间的关联性。结果两组患者基线资料比较显示，共有C2等11项危险因素存在显著差异。经多因素Logistic回归分析验证，低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、血清脂联素(APN)、血浆纤维蛋白原(FIB)、超敏肌钙蛋白I (c-TNI)及C2是ACS患者的独立敏感因素。单因素方差分析显示不同C2水平时FIB及HDL-C的组间资料比较差异均无统计学意义(P>0.05)，而c-TNI、LDL-C、APN的组间资料比较则差异均有统计学意义(P<0.05)。对上述三项指标进行一元线性回归分析，LDL-C与C2呈显著负相关(回归系数=-1.566，Pearson相关系数=0.591，P=0.018)，APN与C2呈显著正相关(回归系数=0.075，Pearson相关系数=0.507，P=0.043)，c-TNI与C2呈非线性相关(P>0.05)。结论 C2水平可作为ACS患者的高危风险因子用于指导临床诊疗，亦可动态评估ACS的病情进展，建议临床推广。
목적：탐토급성관맥종합정(Acute coronary syndrome，ACS)환자감측소동맥탄성지수(C2)수평적림상개치。방법전첨성、련속성납입아원심혈관내과우2011년1월지2013년7월기간소수치신발병적ACS환자，병이동양방식납입동기입원적은정형심교통(Stable angina, SA)환자작위대조조。수집량조환자적림상자료，비교각항위험인소지간적차이성，채용다인소Logistic모형건립회귀분석，진일보사사기중독립、민감적영향지표。경유일원선성회귀분석측정각항민감지표여C2수평지간적관련성。결과량조환자기선자료비교현시，공유C2등11항위험인소존재현저차이。경다인소Logistic회귀분석험증，저밀도지단백(LDL-C)、고밀도지단백(HDL-C)、혈청지련소(APN)、혈장섬유단백원(FIB)、초민기개단백I (c-TNI)급C2시ACS환자적독립민감인소。단인소방차분석현시불동C2수평시FIB급HDL-C적조간자료비교차이균무통계학의의(P>0.05)，이c-TNI、LDL-C、APN적조간자료비교칙차이균유통계학의의(P<0.05)。대상술삼항지표진행일원선성회귀분석，LDL-C여C2정현저부상관(회귀계수=-1.566，Pearson상관계수=0.591，P=0.018)，APN여C2정현저정상관(회귀계수=0.075，Pearson상관계수=0.507，P=0.043)，c-TNI여C2정비선성상관(P>0.05)。결론 C2수평가작위ACS환자적고위풍험인자용우지도림상진료，역가동태평고ACS적병정진전，건의림상추엄。
Objective To investigate the clinical significance of determining small artery elasticity index (C2) in patients with acute coronary syndrome (ACS). Methods Hospitalized ACS patients in the Department of Car-diovascular Medicine from January 2011 to July 2013 were included (the study group), and the stable angina patients were included as the control group. The independent and sensitive indicators were screened by multivariable Logistic regression analysis. The correlation between different C2 levels and the associated sensitive indicators was analyzed by simple linear regression model. Results Comparison on baseline data showed that there were significant differ-ences in a total of 11 risk factors between the two groups, including C2. Multivariate Logistic regression analysis and validation revealed that low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), serum adiponectin (APN), plasma fibrinogen (FIB), high sensitive troponin I (c-TNI) and C2 were the independent sensitive factors of pa-tients with ACS. Single factor analysis showed that at different levels of C2 there was no significant differences in FIB and HDL-C data between the two groups (P>0.05), while differences in c-TNI, LDL-C, APN was statistically signifi-cant (P<0.05). The above three indicators were further included for linear regression analysis. A significant negative cor-relation was found between LDL-C and C2 (regression coefficient=-1.566, Pearson correlation coefficient=0.591, P=0.018), with a significant positive correlation between APN and C2 (regression coefficient=0.075, Pearson correlation coefficient=0.507, P=0.043), and a nonlinear correlation between c-TNI and C2 (P>0.05). Conclusion C2 level could serve as a risk factor of ACS patients to guide clinical intervention, and it is recommended to be popularized in clinic.