2022 年第 12 期 第 17 卷

冠心病患者血浆神经调节蛋白4水平与冠状动脉病变程度相关性研究

Study on the correlation between the level of plasma neuregulin 4 and the degree of coronary artery disease in patients with coronary atherosclerotic heart disease

作者：李姚娜1马茴煌1王康1杨慧宇2

英文作者：Li Yaona1 Ma Huihuang1 Wang Kang1 Yang Huiyu2

单位：1山西医科大学第二临床医学院,太原030001；2山西医科大学第二医院心内科,太原030001

英文单位：1The Second School of Clinical Medicine Shanxi Medical University Taiyuan 030001 China; 2Department of Cardiology Second Hospital of Shanxi Medical University Taiyuan 030001 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；Gensini评分；神经调节蛋白4

英文关键词：Coronaryatheroscleroticheartdisease;Gensiniscore;Neuregulin4

• 摘要：

• 目的  探讨冠心病（冠状动脉粥样硬化性心脏病）患者血浆神经调节蛋白4（NRG4）水平与冠状动脉病变程度（以Gensini评分表示）的相关性。方法  选取2021年6—12月就诊于山西医科大学第二医院并行冠状动脉造影检查确诊为冠心病的患者105例为冠心病组，按Gensini评分三分位数分为G1组（＜15分，n=35）、G2组（15～40分，n=38）、G3组（＞40分，n=32）3个亚组。另外，选取同时期于山西医科大学第二医院行冠状动脉造影结果正常的34例患者为对照组。收集入组人群一般临床资料，酶联免疫吸附试验法检测血浆NRG4水平。分析Gensini评分与各指标的相关性、冠状动脉病变程度的影响因素和血浆NRG4水平对冠心病的预测价值。结果  冠心病组血浆NRG4水平低于对照组［（7.2±1.4）μg/L比（8.1±1.1）μg/L］，差异有统计学意义（P＜0.05）。冠心病组各亚组间血浆NRG4水平：G3组［（6.5±1.4）μg/L］＜G2组［（7.2±1.3）μg/L］＜G1组［（7.8±1.3）μg/L］,组间两两比较差异均有统计学意义（均P＜0.05）。Spearman相关性分析结果显示血浆NRG4、左心室射血分数（LVEF）与Gensini评分呈负相关,空腹血糖与Gensini评分呈正相关（均P＜0.05）。多元有序Logistic回归分析结果显示，男性、年龄、LVEF、NRG4是冠状动脉病变程度的独立影响因素（均P＜0.05）。血浆NRG4预测冠心病的曲线下面积（AUC）为0.702，最佳截断值为7.693 μg/L，敏感度、特异度分别为68.6%、73.5%。空腹血糖预测冠心病的AUC为0.755，最佳截断值为4.9 mmol/L，敏感度、特异度分别为67.6%、76.5%。二者联合预测冠心病的AUC为0.813。结论  冠心病患者血浆NRG4水平较低，且随着冠状动脉病变程度的加重，NRG4水平逐渐降低。NRG4是冠状动脉病变程度的独立影响因素，与冠状动脉病变程度有一定的相关性。

• Objective  To investigate the correlation between the level of plasma neuregulin 4 (NRG4) and the degree of coronary artery disease (expressed by Gensini score) in patients with coronary atherosclerotic heart disease (CHD). Methods  Totally 105 patients with CHD diagnosed by coronary angiography in Second Hospital of Shanxi Medical University from June to December 2021 were selected as CHD group. They were divided into G1 group (＜15, n=35), G2 group (1540, n=38) and G3 group (＞40, n=32) according to tertiles of Gensini score. In addition, 34 people with normal coronary angiography results in Second Hospital of Shanxi Medical University were selected as control group. The general clinical data of the enrolled population were collected, and the plasma NRG4 level was detected by enzymelinked immunosorbent assay. The correlation between Gensini score and each index, the influencing factors of coronary artery disease degree, and the predictive value of plasma NRG4 level in CHD were analyzed. Results  The level of plasma NRG4 in CHD group was lower than that in control group［（7.2±1.4）μg/L vs （8.1±1.1）μg/L］（P＜0.05）. The level of plasma NRG4 among subgroups of CHD group showed G3 group［（6.5±1.4）μg/L］＜G2 group［（7.2±1.3）μg/L］＜G1 group［（7.8±1.3）μg/L］, and the difference between any two groups was statistically significant (all P＜0.05). Spearman correlation analysis showed that plasma NRG4 and left ventricular ejection fraction (LVEF) were negatively correlated to Gensini score, and fasting blood glucose was positively correlated to Gensini score (all P＜0.05). Multiple ordinal Logistic regression analysis showed that male, age, LVEF and NRG4 were the independent influencing factors of the degree of coronary artery disease (all P＜0.05). The area under the curve (AUC) predicted by plasma NRG4 for CHD was 0.702, the cutoff value was 7.693 μg/L, the sensitivity and specificity were 68.6% and 73.5% respectively. The AUC predicted by fasting blood glucose for CHD was 0755, the cutoff value was 4.9 mmol/L, the sensitivity and specificity were 67.6% and 76.5%, respectively. The AUC predicted by combining the two indexes for CHD was 0.813. Conclusions  The plasma NRG4 level in CHD patients is low, and the NRG4 level gradually decreases with the aggravation of coronary artery disease. NRG4 is an independent factor influencing the degree of coronary artery disease, and has certain correlation to the degree of coronary artery disease.