| Objective: The aim of this study was to investigate the severity of coronary artery disease by a combination of growth differentiation factor-15,osteoprotegerin serum levels,and carotid atherosclerosis scores.It can better carry out more accurate risk assessment for patients with acute coronary syndrome in clinical work,enhance medical attention,and effectively preventive measures.It can also reduce the mortality rate of patients with acute coronary syndrome and achieve a better society.Benefits,providing new ideas and directions for the diagnosis of acute coronary syndromeMethods: From August 2017 to August 2018,100 consecutive patients with coronary angiography were enrolled in the Second Clinical Hospital affiliated to Chengde Medical College.The clinical basic data of the patients were collected within 24 hours after admission.All patients received informed consent after admission and collected medical history after admission(history of hyperlipidemia,history of hypertension,history of diabetes,history of smoking,history of drinking);venous blood(liver and kidney function,blood lipids,ions)after admission The next morning,the inspection was carried out under fasting conditions.4 ml of elbow venous blood was taken 1 hour before the start of coronary angiography and centrifuged at 3000 r/min for 15 min.The serum was separated,the supernatant was removed,numbered,and stored in a refrigerator at-80 ° C until use.The serum GDF-15 and OPG levels were determined by ELISA at the same time.The kit was purchased from BIM USA and was performed in strict accordance with the kit instructions.From the carotid artery,ultrasound examination of the carotid artery was performed using a Toshiba Apollo 500 ultrasound system.The common carotid artery and common carotid bifurcation and internal carotid artery were detected in turn,and the carotid intima-media thickness(CIMT)and plaque were observed in the two-dimensional image.Plaque definition: The local echogenic structure protrudes into the lumen and has a thickness greater than 1.5(mm).All subjects who met the inclusion criteria were instructed by a cardiovascular ultrasound physician after coronary angiography.The morphological parameters of the neck artery were measured by the same person on the same machine,and the cervical atherosclerosis grade was integrated and calculated.Crouse score,the sum of the maximum thickness of each plaque.The patient underwent coronary angiography within 1 week of hospitalization,and the SYNTAX score was calculated using computer software based on the angiographic data stored in the computer.According to the Judkins standard multi-position projection,the main branch vessel images were analyzed by experienced cardiologists,and the angiographic results were interpreted and the SYNTAX score was calculated.Grouped according to the SYNTAX scoring system: mild group(1 ≤ SYNTAX score < 21),moderate group(21 ≤ SYNTAX score < 31),and severe group(SYNTAX score ≥ 31).The data were processed by SPSS22.0 statistical software.The measurement data were in accordance with the normal distribution and the variance was expressed by the mean ± standard deviation(?x±s).The comparison between the two groups was performed by the t-test of independent samples.Analysis of variance of factors;the number of count data used was n(%).The comparison between the two groups was performed by χ2 test or Fisher exact probability test.The comparison between multiple groups was performed by Kruskal-Wallis H test.The Spearman correlation analysis was used to test serum GDF-15.Correlation between OPG levels and Crouse scores and SYNTAX.Using all parameters as independent variables,a logistic regression model was established by stepwise regression.Logistic(P)obtained from the regression equation is used as a new variable as a joint detection parameter,and the ROC curve is drawn.P < 0.05 was considered to be significant.Results: 1.Comparison of general data between the two groups of patients Compared with the control group,there was no significant difference in age,gender,smoking level,hypertension history and diabetes history between the experimental group(P>0.05).2.Comparison of biochemical indicators between the two groups of patients There were no significant differences in total cholesterol,triglyceride,creatinine,low-density lipoprotein,calcium ion and high-density lipoprotein between the experimental group and the control group(P>0.05).3.Comparison of serum GDF15,OPG and Crouse scores between the two groups The serum GDF15,OPG and Crouse scores of the experimental group were significantly higher than the control group,and the difference was statistically significant(P<0.05).4.According to the SYNTAX score,the experimental group can be divided into low-risk group,intermediate-risk group and high-risk group,and compare serum GDF15 level,OPG and Crouse score respectively.According to the results of SYNTAX scores,35 patients in the low-risk group,9 patients in the intermediate-risk group,and 6 patients in the high-risk group,and the same factor was significantly different in different groups(all P<0.05).5.Calculate the Spearman correlation coefficient between serum GDF15,OPG and Crouse scores and SYNTAX scores in experimental group.Spearman correlation coefficient of serum GDF-15 concentration and SYNTAX score rs=0.993,P<0.001;Spearman correlation coefficient of serum OPG concentration and SYNTAX score rs=0.820,P<0.001;Spearman correlation coefficient of Crouse score and SYNTAX score rs=0.944,P < 0.001.It is indicated that the above three factors are related to SYNTAX and are positively correlated.6.Calculate the ROC survival curve analysis The sensitivity of combined detection of GDF-15,OPG serum and Crouse score was 80.0%,the specificity was 88.0%,the sensitivity of detecting GDF-15 serum level was 64.0%,the specificity was 78.0%,and the sensitivity of OPG serum level was detected alone.The specificity was 50.0% and the specificity was 88.0%;the sensitivity of the Crouse score alone was 78.0%,and the specificity was 88.0%.Joint detection of the ROC curve(see Figure 1),the detected specificity is the abscissa,and the sensitivity is the ordinate.The area under the curve(0.918)was greater than the area under the curve for the detection of GDF-15 alone(0.724)and the area under the curve for the OPG alone(0.735),and the area under the curve for the Crouse score alone(0.834).The results show that the combined detection effect is better than the separate detection.Conclusion: Conclusion: Combined detection of serum GDF-15,OPG levels and the Crouse score of the cervical artery can better assess the severity of coronary artery disease. |
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