| Objective:1.Analyze the independent risk factors of premature coronary artery disease(PCAD)(the onset age of male<55 years old,female<65 years old)through retrospective research.2.The serum levels of Monocyte Chemoattractant Protein-1(MCP-1)in patients after coronary angiography(CAG)were detected by ELISA to explore the diagnostic value of MCP-1 in PCAD.Part oneMethods:Retrospective collection of general clinical data,biochemical indicators and CAG information of 1,010 patients who underwent coronary angiography in our hospital from January 2016 to February 2017 and were screened by inclusion and exclusion criteria,unordered multi-class Logistic regression model was used to analyze the independent risk factors for PC AD.Results:1.All patients were divided into PCAD group,mature coronary artery disease(MCAD)group,and coronary angiography negative control group(control group)for analysis(1)The independent risk factors(IRF)of PCAD were Smoking(OR=2.20,95%CI:1.29～3.75).Total Cholesterol(TC)(OR=1.99.95%CI=1.06～3.75),The protective factors was High-Density Lipoprotein Cholesterol(HDL-C)(OR=0.28,95%CI:0.09～0.88).(2)The IRF of the MCAD group were male gender(OR=1.63,95%CI=1.08～2.44),Hypertension(OR=2.22,95%CI:1.63～3.03),Diabetes(OR=2.34.95%CI:1.46～3.76).TC(OR=1.93,95%CI=1.10～3.38),The protective factor was Apoliprotein A(APOA)(OR=0.15,9%CI:0.06～0.42).2.Grouped by gender(1)In PCAD,the IRF of male patients was Smoking(OR=2.74,95%CI=1.28～5.86),and the protective factor was HDL-C(OR=0.07,95%CI:0.01～0.51);Female patients’IRP were Hypertension(OR=2.33,95%CI:1.15～4.74),Apoliprotein B(APOB)(OR=6.68:95%CI:2.00-22.32).(2)In MCAD:male patients’ IRF were Hyperten sion(OR=1.99.95%CI:1.21～3.30),Diabetes(OR=2.45:95%CI:1.07～5.61)=APOB(OR=25.46,95%CI:1.17～553.30),the IRF of female patients were Hypertension(OR=2.55,95%CI:1.49～4.39),Homocysteine(HCY)(OR=1.04,95%CI:1.01～1.08),The protective factor was APOA(OR=0.24,95%CI:0.09～0.65).3.Grouped according to the number of coronary artery lesions(1)In PCAD,the IRF of single-vessel disease was Smoking(OR=3.70:95%CI:1.14～11.95);the IRF of double-vessel disease was family history of Hypertension.(OR=3.56,95%CI:1.35～9.39);IRF of multivessel disease were TC(OR=1.91,95%CI:1.04～3.52),family history of Diabetes(OR=19.78,95%CI:1.54～254.09),protective factors was APOA(OR=0.01,95%CI:1.001～0.15).(2)In MCAD,the IRF of single-vessel disease were Hypertension(OR=2.32,95%CI:1.46～3.68),HCY(OR=1.04,95%CI:1.01～1.07);the IRF of double-vessel disease were male gender(OR=2.41,95%CI:1.28～4.53),Hypertension(OR=1.89:95%CI:1.16～3.06);IRF for multi vessel disease were Hypertension(OR=2.22,95%CI:1.46～3.37),Diabetes(OR=2.80,95%CI:1.63～4.81),Cerebrovascular Disease(OR=2.24,95%CI:1.03～4.86),HCY(OR=1.04,95%CI:1.02～1.07),APOB(OR=4.85,95%CI:2.07～11.33),The protective factors mas APOA(OR=0.24:95%CI:0.10-0.59).4.Grouped by diagnostic classification(1)In PCAD,the IRP of the Unstable Angina Pectoris(UAP)group were family history of Diabetes(OR=14.51,95%CI:1.13～186.71),The protective factor was HDL-C(OR=0.08,95%CI:0.01～0.60);the IRF of acute myocardial infarction(AMI)were Smoking(OR=2.21:95%CI:1.002～4.85),Hypertension family history(OR=2.68,95%CI:1.11～6.49),Platelet(PLT)(OR=1.01,95%CI:1.002～1.01),the protective factor was APOA(OR=0.14,95%CI:0.02～0.89).(2)In MCAD:the IRF of the Stable Angina Pectoris(SAP)group were Hypertension.(OR=2.40:95%CI:1.44～3.99),HCY(OR=1.03:95%CI:1.01～1.06),and the IRF of the UAP group were male Gender(OR=2.34,95%CI:1.31～4.17)=Hypertension(OR=2.22,95%CI:1.35～3.65),HCY(OR=1.03,95%CI:1.002～1.06),IRF of the AMI group were Hypertension(OR=2.43,95%CI:1.49～3.97):Diabetes(OR=3.61,95%CI:1.49～8.77),HCY(OR=1.03:95%CI:1.003～1.06),The protective factors was APOA(OR=0.16:95%CI:0.06～0.43).Conclnsion:1.The occurrence of PCAD might be related to Smoking and high serum level of TC,and HDL-C might play a protective role in it.2.The risk factors and protective factors of different groups of PCAD were also different.Among them,family genetic factors greatly increased the possibility of severe clinical types such as double-vessel and multivessel disease,UAP and AMI,but the MCAD group did not have this feature.Part twoMethods:After signing the informed consent form,The serum,clinical data,biochemical indicators and CAG information of 160 patients who underwent CAG in our hospital from October 2019 to February 2020 and were screened by the inclusion and exclusion criteria were collected ELISA was used to detect serum MCP-1 level,and receiver operating characteristic curve(ROC Curve)was used to analyze the diagnostic value of MCP-1 for PCAD.Results:1.Grouped 160 patients into PCAD group,MCAD group and control group for analysis(1)The level of MCP-1 in PCAD group was significantly higher than that in the MCAD group and Coronary angiography negative control group(negative group),and the difference was statistically significant(P<0.05).The logistic regression model showed that the increase of MCP-1(OR=1.01,95%CI:1.00～1.013)and Neutrophil(N)(OR=1.54,95%CI:1.02～2.32)levels increased the risk of PCAD.(2)Male gender(OR=4.00,95%CI=1.24～12.89)increased the risk of MCAD,and the increase of the Ratio of Lymphocytes to Monocytes(LMR)(OR=0.73,95%CI=0.54～0.99)reduced the risk of MCAD.2.Spearman’s relevant analysis showed that(1)the Gensini score of PCAD was positively correlated with the Ratio of Neutrophil to Lymphocytes(NLR).(2)The Gensini score of MCAD was positively correlated with blood N level,and the difference was statistically significant(P<0.05).3.The area under the ROC curve showed that(1)The area under the ROC curve of each index for the diagnostic value of PCAD showed that the area under the curve of Monocytes(M),the Ratio of Monocytes to High-Density Lipoprotein Cholesterol(MHR),the Ratio of Monocytes to Lymphocytes(MLR),the Ratio of Apoliprotein A to Apoliprotein B(APOB/APOA)was greater than 0.5 but less than 0.7,which had low diagnostic value for PCAD(P<0.05).The area under the ROC curve of MCP-1,N,and NLR was greater than 0.7 but less than 0.9,which had a certain diagnostic value for PCAD(P<0.05).Among them,the area under the ROC curve of MCP-1 was 0.720.When the Youden index took the maximum value of 0.359 and the cut-off value was 246.63 pg/ml,its diagnostic effect was the largest,with a sensitivity of 78.3%and a specificity of 57.6%.(2)The area under the ROC curve of each index for the diagnostic value of MCAD showed that the area under the curve of 1/L was greater than 0.5 but less than 0.7,which had low diagnostic value for MCAD(P<0.05).The area under the ROC curve of N、NLR and MLR was greater than 0.7 but less than 0.9,which has a certain diagnostic value for MCAD(P<0.05).MCP-1 had no significant significance in the diagnosis of MCAD(P>0.05).4-Grouped 160 patients into Myocardial Infarction(MI)group,Non-Myocardial Infarction(Non-MI)group and control group for analysis(1)The level of MCP-1 in the myocardial infarction(MI)group was significantly higher than that in the negative group and the non-myocardial infarction(Non-MI)group.Logistic regression model showed that there was no significant difference between the Non-MI group and the coronary angiography negative control group(P>0.05).Compared with the control group,the high serum levels of MCP-1(OR=1.01,95%CI=1.001～1.013)and NLR(OR=1.92,95%CI=1.34～2.76)increased the risk of disease in the MI group.(2)The area under the ROC curve of each index for the diagnostic value of MI showed that the area under the curve of MCP-1、APOB/APOA、MHR、Triglyceride-glucose Index、M、APOB was greater than 0.5 but less than 0.7,which had low diagnostic value for MI(P<0.05).Among them,the area under the ROC curve of MCP-1 was 0.658.When the Youden index took the maximum value of 0.297 and the cut-off value was 268.84 pg/ml,its diagnostic effect was the largest,with a sensitivity of 63.0%and a specificity of 66.7%.The area under the ROC curve of MLR、MLR and N was greater than 0.7 but less than 0.9,which had a certain diagnostic value for MI(P<0.05).Cnclusion:The occurrence of PCAD might be related to the high serum level of MCP-1 and N,and the Serum MCP-1 was an independent risk factor for PCAD and had a certain diagnostic value for PCAD. |
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