| Objective:To observe the levels of serum von Willebrand factor-cleaving protease（ADAMTS13）and thrombospondin 1（TSP1）in patients with different types of acute coronary syndrome（ACS）and their correlation with clinical prognosis.Method:1.A total of 401 patients who underwent coronary angiography in the First Affiliated Hospital of Bengbu Medical College were selected and divided into: unstable angina pectoris group（UAP group,n=215）and acute myocardial infarction group（AMI group,n =94）according to the medical history,angiography results and clinical biochemical indexes)and angiography normal group（N group,n =92）.At the same time,they were divided into hypertensive group（n =247）and non-hypertensive group（n =154）according to whether they were complicated with hypertension,and divided into diabetes group（n =100）and non-diabetic group（n =301）according to whether they were complicated with diabetes.Clinical data and test indexes of all subjects.2.Enzyme-linked immunosorbent assay（ELISA）was used to detect the serum ADAMTS13 and TSP1 levels of the included subjects,and the differences in the baseline data and related indicators of patients in each group were analyzed.3.According to the results of coronary angiography,the patients in the ACS group were further divided into a single-vessel disease group（n =58）,a double-vessel disease group（n =100）and a three-vessel disease group（n =151）.Serum ADAMTS13 and TSP1 levels of patients.At the same time,the correlation of ADAMTS13 and TSP1 in serum of ACS patients was observed.4.The patients in the ACS group were followed up for an average of 15 months,and8 of the 309 ACS patients were lost to follow-up.According to the occurrence of major adverse cardiovascular events（Maces）,the subjects were divided into the Maces group（n =39）and the non-Maces group（n =262）.The clinical data between the groups were compared and the Cox proportional hazards regression model was used.To analyze the risk factors of Maces in patients with ACS.5.ROC curve and Kaplan-Meier survival analysis were used to evaluate the predictive value of serum ADAMTS13 and TSP1 levels on the prognosis of ACS patients.Results:1.There were no significant differences in ADAMTS13 and TSP1 between groups of different genders,with or without hypertension and diabetes（P>0.05）.Compared with the control group,the levels of serum TSP1 in the UAP group and the AMI group were increased（P <0.001）;there was no significant difference in the level of TSP1 between the AMI group and the UAP group（P >0.05）.The serum ADAMTS13 levels in the UAP group and the AMI group were lower than those in the control group（P<0.001）;the serum ADAMTS13 level in the AMI group was not significantly different from that in the UAP group（P >0.05）.2.With the increase of coronary lesions,the serum TSP1 level showed an upward trend（P <0.05）,while the serum ADAMTS13 level showed a downward trend（P<0.05）.3.Pearman correlation coefficient analysis showed that the content of TSP1 was significantly increased when the level of ADAMTS13 was decreased,and the two were negatively correlated（R =-0.577,P < 0.001）.4.Compared with the non-Maces group,TSP1,GLU,and the proportion of diabetes mellitus in the Maces group were significantly higher（P <0.05）,but there was no significant difference in ADAMTS13.The Cox proportional hazards regression model analysis of TSP1 and GLU with differences in baseline data between the Maces group and the non-Maces group showed that with the preoperative TSP1 and GLU levels in ACS patients increasing,the risk of postoperative Maces events in ACS patients was significantly higher in different models.were significantly increased accordingly.5.ROC curve analysis showed that the cutoff values of TSP1 and GLU for predicting postoperative Maces events in ACS patients were 31.27 ng/m L and 5.89 mmol/L,respectively.The K-M curve showed that patients with TSP1 level greater than 31.27ng/m L and GLU level greater than 5.89 mmol/L had a higher risk of Maces events than patients in the smaller group（P =0.001）.Conclusion:1.The expression level of serum ADAMTS13 in the ACS group was significantly lower than that in the control group,while the expression level of serum TSP1 was significantly higher than that in the control group.2.With the increase of coronary lesions,the serum TSP1 level showed an upward trend,and the ADAMTS13 level showed a downward trend.And there was a significant negative correlation between serum ADAMTS13 and TSP1 levels in ACS patients.3.TSP1 and GLU levels are independent risk factors for Maces in ACS patients;TSP1 is more valuable than GLU level in predicting the occurrence of major adverse cardiovascular events in ACS patients outside the hospital. |
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