论文部分内容阅读
目的 探讨血清非对称二甲基精氨酸(ADMA)、胱抑素C(CysC)在退行性钙化性主动脉瓣膜病诊断中的应用价值.方法 选取2016年6月至2018年6月首都医科大学附属北京潞河医院心脏外科收治的180例退行性钙化性主动脉瓣膜病患者作为研究对象,选择同期医院体检82例健康者作为对照组.分别采用酶联免疫吸附法和胶乳增强免疫透射比浊法检测血清ADMA、CysC水平.应用Logistic回归分析影响退行性钙化性主动脉瓣膜病的危险因素,采用受试者工作特征曲线(ROC曲线)评价血清ADMA、CysC对退行性钙化性主动脉瓣膜病的诊断效能.结果 两组年龄、性别构成、体质量指数、饮酒史、吸烟史、高血压史等一般资料比较差异无统计学意义(P＞0.05);研究组收缩压(SBP)、舒张压(DBP)、心率(HR)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、CysC、ADMA水平显著高于对照组[(131.51±19.09) mmHg(1 mmHg=0.133 kPa)比(126.48±16.68) mmHg、(91.11±16.35) mmHg比(86.89±10.71) mmHg、(74.39±15.22)次/min比(70.09±13.01)次/min、(4.51±1.12) mmol/L比(4.15±0.92) mmol/L、(1.91±0.63) mmol/L比(1.60±0.65)mmol/L、(2.59±1.13) mmol/L比(2.27±0.85) mmol/L、(1.01±0.22) mg/L比(0.79±0.16) mg/L、(20.17±6.38) ng/L比(11.88±4.22) ng/L],左心室射血分数(LVEF)、高密度脂蛋白胆固醇(HDL-C)显著低于对照组[(56.45±9.21)％比(60.87±10.02)％、(1.56±0.63) mmol/L比(1.76±0.62) mmol/L],差异均有统计学意义(P＜0.05).Logistic多因素回归分析显示,CysC、ADMA是退行性钙化性主动脉瓣膜病的独立危险因素(均P＜0.05).ROC曲线分析显示,血清CysC鉴别退行性钙化性主动脉瓣膜病曲线下面积(AUC)为0.785,灵敏度为71.67％,特异度为73.17％;血清ADMA鉴别退行性钙化性主动脉瓣膜病的AUC为0.862,灵敏度为71.67％,特异度为87.80％;二者联合诊断AUC为0.910,灵敏度为85.56％,特异度为84.15％,明显高于CysC、ADMA单独检测(Z=4.897、3.335,P＜0.05).结论 血清ADMA与CysC水平检测在退行性钙化性主动脉瓣膜病诊断中有较高的临床应用价值.“,”Objective To investigate the correlation between serum asymmetric dimethylarginine (ADMA) and cystatin C (CysC) in degenerative calcific aortic valvular disease and its clinical application value.Methods One hundred and eighty patients with degenerative calcific aortic valvular disease who were treated in Beijing Luhe Hospital Affiliated to Capital Medical University from June 2016 to June 2018 were selected as the study subjects,and another 82 healthy subjects from the same hospital in the same period were selected as the control group.Serum ADMA and CysC levels were detected by enzyme-linked immunosorbent assay and latex-enhanced immunoturbidimetric assay.Risk factors of degenerative calcific aortic valvular disease were analyzed by Logistic regression analysis.Evaluation of the diagnostic efficacy of serum ADMA and CysC for degenerative calcific aortic valvular disease was used by receiver operating characteristic curve.Results There were no significant differences in the general data between the two groups in terms of age,gender,body mass index,drinking history,smoking history,and history of hypertension (P＞ 0.05).The systolic blood pressure(SBP),diastolic blood pressure (DBP),heart rate (HR),total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterin(LDL-C),CysC and ADMA levels of the study group were significantly higher than those of the control group [(131.51 ± 19.09) mmHg (1 mmHg=0.133 kPa) vs.(126.48 ± 16.68) mmHg,(91.11 ± 16.35) mmHg vs.(86.89 ± 10.71) mmHg,(74.39 ± 15.22) beats/min vs.(70.09 ± 13.01)beats/min,(4.51 ± 1.12) mmol/L vs.(4.15 ± 0.92) mmol/L,(1.91 ± 0.63) mmol/L vs.(1.60 ± 0.65) mmol/L,(2.59 ± 1.13) mmol/L vs.(2.27 ± 0.85) mmol/L,(1.01 ± 0.22) mg/L vs.(0.79 ± 0.16) mg/L,(20.17 ± 6.38)ng/L vs.(11.88 ± 4.22) ng/L],and left ventricular ejection fraction (LVEF),high density lipoprotein cholesterin (HDL-C) levels were significantly lower than those of the control group [(56.45 ± 9.21)％vs.(60.87 ± 10.02)％,(1.56 ± 0.63) mmol/L vs.(1.76 ± 0.62) mmol/L],there were significant differences (P ＜ 0.05).Logistic multivariate regression analysis showed that serum CysC and ADMA were independent risk factors for degenerative calcific aortic valvular disease (P ＜ 0.05).Receiver operator characteristic (ROC) curve analysis showed that area under curve (AUC) of serum CysC for degenerative valvular heart disease was 0.785,with a sensitivity of 71.67％,and a specificity of 73.17％.The AUC of serum ADMA for degenerative valvular heart disease was 0.862,with a sensitivity of 71.67％,and a specificity of 87.80％.The AUC of serum CysC combined with ADMA in the diagnosis of degenerative valvular heart disease was 0.910,with a sensitivity of 85.56％,and a specificity of 84.15％,which was significantly higher than the two alone (Z =4.897 and 3.335,P ＜ 0.05).Conclusions Serum ADMA is positively correlated with CysC in patients with degenerative valvular heart disease,and can be used as diagnostic serum markers for degenerative calcific aortic valvular disease.It has clinical reference value for improving the diagnosis of degenerative calcific aortic valvular disease.