| Objectives:Combined detection the concentration of N-terminal pro-brain natriuretic peptide(NT-proBNP),lipoprotein(a)(Lp(a)),β2-microglobulin(β2-MG)in the serum of patients with acute coronary syndrome,the paper studied the effects of NT-proBNP,Lp(a)and β2-MG single and their combination test on the assessment of ACS and severity of coronary lesions,in order to select the optimal indicators for the diagnosis of severe coronary artery stenosis.Methods: Patients who are suspected of having ACS due to chest pain were randomly selected in department of cardiology,Affiliated Hospital of Cardiovascular and Cerebrovascular Diseases,Yan’an University from January,2017 to November,2017.Coronary angiography(Coronary AterioGraphy,CAG)examined 174 inpatients.A total of 132 cases of ACS were diagnosed.Based on clinical manifestations,serum markers of myocardial injury,ECG changes,and CAG results.They were divided into the following groups: unstable angina pectoris group with 40 patients,non-ST-segment elevation myocardial infarction group with 48 patients,ST-segment elevation myocardial infarction group with 44 patients,and the control group of negative CAG results with 42.The levels of serum NT-proBNP,Lp(a),and β2-MG were measured.we recorded the number of coronary lesions and calculated Gensini score of coronary lesions according to CAG result.Objective to analyze the value of serum NT-proBNP,Lp(a)and β2-MG in evaluating the severity and severity of coronary artery disease in ACS patients.Simultaneously,By plotting the receiver operating characteristic curve,calculating the sensitivity,specificity,the positive and negative predictive value,Kappa value,we studied the effects of between the value of single and combined detection in patients’ plasma and severe coronary artery stenosis diagnosis critical value and screened out the optimal index for diagnosis of severe coronary artery stenosis.By using SPSS19.0 software for statistical analysis,the difference was statistically significant withP<0.05.Results:1.Comparison of general clinical data between ACS three subgroups and control groups:Our study showed no statistical significance in groups of gender,history of smoking,history of hypertension,history of diabetes,family history of coronary heart disease,TC,TG,LDL-C,Scr,BUN.There was a statistically significant difference between groups in age and HDL-C(P<0.01).The difference in their age between the control group and UAP group,NSTEMI group,and STEMI group was statistically significant(P<0.01).The levels of HDL-C in the control group,UAP group,and STEMI group were higher than those in the NSTEMI group(P<0.0083).2.Comparison of levels of NT-proBNP,Lp(a)and β2-MG in three subgroups of ACS and controls:There was a significant difference in serum levels of NT-proBNP,Lp(a),and β2-MG between groups(P<0.01).The levels of NT-proBNP in UAP group,NSTEMI group,and STEMI group were significantly higher than those in control group(P<0.0083).Serum NT-proBNP levels were significantly higher in the STEMI group than in the UAP group(P<0.0083).The levels of Lp(a)levels in NSTEMI and STEMI patients were higher than those in controls(P<0.0083).The levels of β2-MG in three ACS subgroups were higher than those in controls(P<0.01).3.Correlation analysis between cTnI and NT-proBNP,Lp(a)and β2-MG levels in NSTEMI and STEMI:There was a positive correlation between cTnI levels and NT-proBNP levels in AMI patients(r=0.41,P<0.01).There was no correlation between cTnI and Lp(a)and β2-MG levels(r=0.045,0.145,P>0.05).4.Analysis of the positive rate of NT-proBNP,Lp(a),β2-MG and the combination of them among different coronary lesions:The positive rates of combined index was contrasted the levels of NT-proBNP,Lp(a),β2-MG,NT-proBNP+Lp(a)+β2-MG in ACS each groups,which showed the difference was statistically significant(P<0.05).And multi-vessel disease group were more than single-vessel disease group in the combined positive rates of NT-proBNP+Lp(a)+β2-MG and NT-proBNP in their serum(P<0.017);The positive rates of β2-MG was highest in all group(P<0.017).The data showed that there was no difference in the positive rate of Lp(a)in the two disease groups.5.Gensini score and NT-proBNP,Lp(a),β2-MG level correlation analysis:The correlation coefficient between Gensini score and NT-proBNP,Lp(a)levels was respectively 0.445,0.385.(P<0.01),suggesting that both NT-proBNP and Lp(a)had an increasing trend with the increase of Gensini’s integral value.However,the correlation coefficient between Gensini score and β2-MG level was r=0.145(P>0.05),indicating there were no correlation between Gensini score and β2-MG level.6.ROC curve analysis of severe coronary artery stenosis by NT-proBNP,Lp(a),β2-MG and NT-proBNP+Lp(a)+β2-MG:The combined index including NT-proBNP,Lp(a),β2-MG and NT-proBNP+Lp(a)+β2-MG were used as test variables.According to Coronary Angiography Gensini score,they were divided into case group that the Gensini score were equal or greater than 30(Positive event)and control groups that the Gensini score were in the range of 1 to 29(Negative event).We plotted ROC curves according to the patient’s state variables.The result showed that AUC value and Cutoff value were respectively 0.754,372pg/ml;0.670,78.355mg/L;0.579,2.04mg/L;0.760 in the ROC curves was potted to be combined NT-proBNP,Lp(a),β2-MG and NT-proBNP+Lp(a)+β2-MG.Statistical analysis showed the combined detection index of NT-proBNP+Lp(a)+β2-MG was better than the single index in diagnostic indicators,but compared with Lp(a)and β2-MG,the index of NT-proBNP was the best diagnostic indicator.7.The diagnostic value of NT-proBNP,Lp(a),β2-MG and NT-proBNP+Lp(a)+β2-MG in the diagnosis of severe coronary artery stenosis:The diagnostic cut-off point of NT-proBNP ≥ 372pg/ml,Lp(a)≥ 78.355 mg/L,and β2-MG ≥ 2.04 mg/L was considered as the positive decisive point.We transformed the measurement data of the selected subjects into count data.At the same time,the optimal diagnostic indicators for severe coronary artery stenosis were screened and evaluated for diagnostic test efficacy.The result showed Lp(a)sensitivity(89.89%)for diagnosing severe coronary artery stenosis was superior to β2-MG(60.67%)(P<0.0083).The sensitivity(95.51%)and negative predictive value combined detection(90.70%)of NT-proBNP+Lp(a)+β2-MG were higher than NT-proBNP(75.28%、58.49%)、β2-MG(60.67%、43.55%)measured separately(P<0.0083).The three combined detection severity of diagnosis of severe coronary artery stenosis(90.70%)and positive predictive value(95.51%)of NT-proBNP+Lp(a)+β2-MG were higher than Lp(a)(46.51%、77.67%)、β2-MG(62.79%、77.14%)measured separately(P<0.0083).And the three combined index Kappa value that it equaled to 0.86 was higher obviously than the Kappa value of NT-proBNP 、 Lp(a)、 β2-MG.Therefore,the diagnostic value of combined NT-proBNP+Lp(a)+ β2-MG for Severe Coronary Artery Stenosis was better than the three measured separately(P<0.05).Conclusions:1.The level of NT-proBNP、Lp(a)and β2-MG in the patient with ACS was related ACS serious situation.2.NT-proBNP can be used to determine the severity of myocardial infarction in AMI patients.3.NT-proBNP,Lp(a),and β2-MG were closely related to the severity of coronary lesions.4.The three combined indicators NT-proBNP+Lp(a)+β2-MG was optimal combination and was greater than that measured separately in the diagnosis of severe coronary artery stenosis. |
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