| Objective:To investigate the correlation between the levels of Chemerin,RANTES and MHR and the degree of coronary artery stenosis in acute coronary syndrome(ACS)and the diagnostic efficacy of ACS,so as to provide objective reference for clinical treatment management and non-invasive risk stratification of diseases in the future.Methods:From July 2019 to January 2020,the 227 patients underwent coronary angiography,who conform to ACS diagnostic criteria,in the department of cardiology of our hospital.Including 152 patients with non-ST segment elevation acute coronary syndrome(NSTE-ACS group)and 75 patients with ST segment elevation myocardial infarction(ST segment elevation myocardial infarction group)75 cases(STEMI group).Coronary angiography was performed at the same time for suspected coronary heart disease.There was no obvious stenosis of coronary artery(there was no stenosis or stenosis < 50% of the main branch of coronary artery)104 cases as control group.According to the median Gensini score,ACS patients were divided into high group(≥ 43 scores,n = 115)and low group(< 43 scores,n= 112).The levels of Chemerin,RANTES and MHR in NSTE ACS group,STEMI group and control group were compared,and their correlation with the severity of coronary artery stenosis was compared.Results:1.Comparison of clinical baseline features among the three groups:Compared with the control group,the age of onset in NSTE-ACS group(60.36 ±8.76)years was higher than that in STEMI group(56.37 ±10.93) years and control group(57.15 ±9.30)years(P < 0.01).The proportion of smoking(49.34% VS 69.33% VS 22.12%),hypertension(63.82% VS 52.00% VS 40.38%)and diabetes mellitus(22.37% VS 29.33% VS 8.65%)in NSTE-ACS and STEMI group were higher than those in control group(P < 0.01).Lymphocyte count was 1.62(1.26,2.10)VS 1.31(0.89,1.80)VS 1.66(1.28,2.03)× 109 / L,neutrophil count was 4.14(3.23,5.18)VS 8.66(6.77,11.16)VS 3.82(3.12,4.82)× 109 / L,monocyte count was 0.39(0.33,0.49)VS 0.47(0.31,0.65)VS 0.34(0.28,0.46)× 109 / L,total cholesterol was4.20(3.45,4.94)VS 4.61(4.04,5.37)VS 4.31(3.82,4.92)mmol / L,triglyceride was 1.62(1.04,2.71)VS 1.03(0.63,1.83)VS 1.52(0.90,2.58)mmol/L,low-density lipoprotein cholesterol was 2.19(1.63,2.91)VS 2.96(2.25,3.47)VS 2.33(1.63,2.86)mmol /L,high-density lipoprotein cholesterol was 0.98(0.83,1.15)VS 1.04(0.88,1.20)VS 1.09(0.96,1.28)mmol / L,there was statistical difference among the three groups(P < 0.01).The neutrophil count and LDL-C level in STEMI group were significantly higher than those in the other two groups(P < 0.01).The left ventricular ejection fraction was 63.00(58.00,67.00)VS 56.00(46.00,59.00)VS 64.00(59.50,67.75)% in STEMI group,which was lower than the other two groups(P < 0.01).But left ventricular end diastolic diameter was 50.00(47.00,52.00)VS 52.00(48.00,55.00)VS 48.00(46.00,51.00)mm,which was higher than the other two groups(P < 0.01).Gensini scores 32.00(15.25,55.50)VS 51.00(43.00,74.00)VS 1.00(0.00,3.38)showed that the scores of STEMI group was significantly higher than that of the other two groups(P < 0.01).2.Comparison of the changes of Chemerin,RANTES and MHR concentrations among the three groups:There were significant differences among NSTE-ACS group,STEMI group and control group,which were Chemerin:683.25(555.38,804.75)VS818.00(696.50,927.00)VS 602.50(519.63,699.13)ng/ml;RANTES:29.01(24.24,34.56)VS 31.82(27.12,36.56)VS 22.60(17.76,26.89)ng/ml;MHR:0.41(0.30,0.51)VS 0.44(0.27,0.62)VS 0.31(0.23,0.45)(P < 0.01).The levels of Chemerin,RANTES in STEMI group were significantly higher than those in NSTE-ACS group and control group(P < 0.05).The level of MHR in STEMI group and NSTE-ACS group was significantly higher than that in control group(P < 0.01),but there was no significant difference between STEMI group and NSTE-ACS group(P > 0.05).3.Comparison of Chemerin,RANTES and MHR levels among different Gensini score groups:According to the median Gensini scores of ACS patients,the Gensini scores was divided into high score group(≥ 43,n ≥ 115)and low score group(< 43,n ≤ 112).The levels of Chemerin,RANTES and MHR in peripheral circulation serum of high Gensini group were significantly higher than those of low Gensini score group,which were Chemerin: 790.50(645.00,903.50)VS683.25(562.38,780.75)ng/ml;RANTES: 32.86(28.29,36.45)VS 26.99(23.68,32.99)ng/ml;MHR:0.48(0.33,0.76)VS 0.40(0.29,0.51),the difference was statistically significant(P < 0.01).4.Analysis of the correlation between the levels of Chemerin,RANTES and MHR in peripheral circulation blood and the degree of coronary artery stenosis:Spearman rank correlation analysis: the levels of Chemerin,RANTES and MHR in peripheral circulation serum were positively correlated with Gensini scores,and the correlation coefficients(Rs)were as follows: 0.221,0.289,0.221,the difference was statistically significant(P < 0.05).5.Evaluation of diagnostic effectiveness of Chemerin,RANTES and MHR for ACS:The ROC curve showed that the area under the Chemerin curve was0.715(95% CI: 0.659-0.770).The area under RANTES curve was 0.799(95% CI: 0.750-0.848).The area under ROC curve of MHR was 0.636(95%CI: 0.571-0.701),and the differences were statistically significant(P < 0.05).The best cut-off values of Chemerin,RANTES and MHR were 723.75ng/ml,26.52ng/ml and 0.34.The sensitivity was 47.1%,68.3%,66.1%,and the specificity was 89.4%,75.00%,61.5%.The area under ROC curve of combined Chemerin,RANTES and MHR increased to 0.837(95% CI:0.792-0.883,P < 0.05).6.Analysis of multiple risk factors for ACS:In univariate analysis,smoking,hypertension,diabetes,systolic blood pressure,neutrophil count,monocyte count,high-density lipoprotein cholesterol,creatinine,left ventricular ejection fraction,left ventricular end diastolic diameter,body mass index,Chemerin,RANTES,and MHR(P <0.05)were taken as independent variables,and ACS was taken as dependent variable to construct binary logistic regression model regression model.Stepwise adjustment showed that smoking,diabetes,systolic blood pressure,neutrophil count,high-density lipoprotein cholesterol,Chemerin ≥723.75ng/ml,RANTES ≥ 26.52ng/ml were all independent risk factors for ACS(P < 0.05).In this study,the risk of ACS in smokers was 3.915 times higher than that in non-smokers(P < 0.05);the risk of ACS in people with diabetes was 4.301 times higher than that in people without diabetes(P <0.05).When Chemerin ≥ 723.75ng/ml and RANTES ≥ 26.52ng/ml,the risk of ACS increased 3.549 times and 4.208 times.The model can predict 80.1%of ACS patients in this study.Conclusion:1.The levels of inflammatory factors Chemerin,RANTES and MHR in peripheral circulation of ACS patients were higher than those of non-coronary heart disease patients at the same time,which had certain reference value for auxiliary recognition of ACS.2.The changes of serum inflammatory factors Chemerin,RANTES and MHR levels were different in different Gensini score groups,which were positively correlated with Gensini score.According to the change of its concentration level,the degree of coronary artery stenosis was preliminarily evaluated.3.Chemerin ≥ 723.75ng/ml and RANTES ≥ 26.52ng/ml in peripheral circulation serum can be used as independent risk factors for ACS. |
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