早期生长反应因子3和白介素6水平与冠状动脉粥样硬化性心脏病的相关性研究

doi:10.12114/j.issn.1007-9572.2023.0051

摘要/Abstract

摘要： 背景冠状动脉粥样硬化性心脏病（CHD）是全球导致死亡的主要原因，冠状动脉造影检查通常作为诊断CHD的有效手段，但在基层受多种条件限制导致冠状动脉造影检查率较低，需要研究更有意义的生物标志物为基层医生诊治CHD提供依据。课题组在前期研究中发现，早期生长反应因子3（Egr3）基因可能是CHD发病异质性的易感因素，目前关于CHD与Egr3基因及炎症指标的相关性鲜有报道。目的探讨Egr3、白介素6（IL-6）与CHD的相关性及其水平与冠状动脉粥样硬化严重程度的关系，为临床基层诊治提供依据。方法纳入2021年6—12月就诊于新疆医科大学第五附属医院的CHD患者110例，参与者均因CHD症状就诊并完善冠状动脉造影检查，将确诊为CHD的患者依据Gensini评分的中位数（52分）分为轻度狭窄组（A组≤52分，n=50）、中重度狭窄组（B组>52分，n=30），选取冠状动脉造影结果正常的30例为对照组（C组）。采用ELISA检测法检测患者血清Egr3水平及IL-6水平。结果 B组IL-6水平高于A组与C组（P<0.05），A组、B组Egr3水平高于C组（P<0.05）；Egr3水平诊断CHD的受试者工作特征曲线下面积为0.648，灵敏度为35.0%，特异度为93.3%。CHD患者IL-6与Egr3呈正相关（r=0.231，P<0.01）；Egr3、IL-6与Gensini评分呈正相关（rs=0.390、0.317，P<0.01）。结论 Egr3对CHD的诊断具有良好的特异度，Egr3水平与IL-6水平与冠状动脉血管病变程度呈正相关。

关键词: 冠心病, 早期生长因子3, 胞间信号肽类和蛋白质类, 白细胞介素6, Gensini评分, 冠状动脉狭窄, 相关性

Abstract:

Background

Coronary heart disease (CHD) is the leading cause of death world wide. Coronary angiography is often used as an effective approach for the diagnosis of CHD. However, coronary angiography accounts for relatively low percentagein examination approaches due to the limitation of various conditions in primary care, and more meaningful biomarkers need to be explored to provide a basis for primary care physicians to diagnose and treat CHD. In the previous study of our research group, it is found that early growth response 3 (Egr3) gene may be a susceptibility factor in the heterogeneity of CHD pathogenesis, and there are few reports on the correlation between CHD and Egr3 gene and inflammatory biomarkers.

Objective

To investigate the correlation between Egr3, interleukin-6 (IL-6) and CHD, as well as their expression levels and the severity of coronary stenosis, so as to provide a favorable laboratory basis for clinical diagnosis and treatment inprimary care.

Methods

A total of 110 patients who admitted to the Fifth Affiliated Hospital of Xinjiang Medical University for CHD symptoms and completed coronary artery angiography (CAG) during June to December 2021 were collected and divided into the mild stenosis group (group A≤52 points, n=50) , moderate-severe stenosis group (group B>52 points, n=30) and control group (group C, n=30) according to the CAG results and median Gensini score (52 points) . Serum Egr3 and IL-6 levels of the included patients were measured by enzyme-linked immunosorbent assay.

Results

The IL-6 level in group B was higher than that in group A and group C (P<0.05) , and Egr3 expression level in the group A and group B was higher than that in group C, respectively (P<0.05) ; the area under the ROC curve of Egr3 expression level in the diagnosis of coronary heart disease was 0.648, with a sensitivity of 35.0% and specificity of 93.3%. There was positive correlation between IL-6 and Egr3 in CHD patients (r=0.231, P<0.01) ; Egr3 and IL-6 levels were positively correlated with Gensini score (r_s=0.39, 0.317, P<0.01) .

Conclusions

Egr3 has good specificity for the diagnosis of CHD, and the expression levels of Egr3 and IL-6 were positively correlated with the severity of coronary stenosis.

Key words: Coronary disease, Early growth response 3, Intercellular signaling peptides and proteins, Interleukin-6, Gensini score, Coronary stenosis, Correlation analysis

祖姆热提·阿布都克依木,马燕玲,朱凯瑞,等. 早期生长反应因子3和白介素6水平与冠状动脉粥样硬化性心脏病的相关性研究[J]. 中国全科医学, 2023, 26(24): 3016-3021. DOI: 10.12114/j.issn.1007-9572.2023.0051.
ZUMURETI ·Abudukeyimu,MA Yanlin,ZHU Kairui, et al. Correlation of Early Growth Response 3 and Interleukin 6 Expression Levels with Coronary Heart Disease[J]. Chinese General Practice, 2023, 26(24): 3016-3021. DOI: 10.12114/j.issn.1007-9572.2023.0051.

图/表 8

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冠状动脉狭窄程度	权重系数	狭窄程度	评分（分）
左主干病变	5.0	1%~25%	1
左前降支近段、回旋支近段病变	2.5	26%~50%	2
前降支中段病变	1.5	51%~75%	4
前降支远段、回旋支中段、回旋支远段病变	1.0	76%~90%	8
左心室后侧支、钝缘支动脉、第一对角支、心尖支病变	1.0	91%~99%	16
右冠状动脉病变	1.0	100%	32
第二对角支病变	0.5

冠状动脉狭窄程度	权重系数	狭窄程度	评分（分）
左主干病变	5.0	1%~25%	1
左前降支近段、回旋支近段病变	2.5	26%~50%	2
前降支中段病变	1.5	51%~75%	4
前降支远段、回旋支中段、回旋支远段病变	1.0	76%~90%	8
左心室后侧支、钝缘支动脉、第一对角支、心尖支病变	1.0	91%~99%	16
右冠状动脉病变	1.0	100%	32
第二对角支病变	0.5

组别	例数	年龄（岁）	性别（男/女）	吸烟史〔例（%）〕	BMI （kg/m²）	TC （mmol/L）	LDL-C （mmol/L）	HDL-C （mmol/L）	TG （mmol/L）
A组	50	63.2±10.1	22/28	13（26.0）	25.3±2.9	4.27±1.11	2.58±0.96	1.51±0.28	1.77±1.27
B组	30	62.4±11.2	7/23	11（33.3）	24.9±3.2	4.12±1.14	2.60±0.98	1.41±0.29	1.77±1.03
C组	30	62.1± 5.9	9/21	7（21.2）	26.0±4.1	4.54±1.06	2.84±0.87	1.59±0.37	1.77±1.05
F（χ²）值		1.659	14.02	1.270^a	0.862	1.131	0.809	2.277	0.109
P值		0.195	0.001	0.530	0.425	0.326	0.448	0.108	0.897
组别	Glu （mmol/L）	WBC （×10⁹/L）	HR （次/min）	高血压〔例（%）〕	糖尿病〔例（%）〕	LVEF （%）	收缩压（mmHg）	舒张压（mmHg）
A组	7.08±2.59	6.75±1.73	76±13	38（51.4）	19（38.0）	64.38±5.83	134±20	81±10
B组	7.83±3.70	6.85±1.69	76±13	23（31.1）	14（46.6）	61.10±7.33	129±19	74±14
C组	6.11±2.20	5.98±1.25	81±16	13（17.6）	8（26.7）	65.10±4.77	131±20	82±14
F（χ²）值	2.764	2.943	1.486	10.74^a	0.688^a	3.916	0.499	3.694
P值	0.068	0.057	0.231	0.005	0.335	0.023	0.690	0.028

组别	例数	年龄（岁）	性别（男/女）	吸烟史〔例（%）〕	BMI （kg/m²）	TC （mmol/L）	LDL-C （mmol/L）	HDL-C （mmol/L）	TG （mmol/L）
A组	50	63.2±10.1	22/28	13（26.0）	25.3±2.9	4.27±1.11	2.58±0.96	1.51±0.28	1.77±1.27
B组	30	62.4±11.2	7/23	11（33.3）	24.9±3.2	4.12±1.14	2.60±0.98	1.41±0.29	1.77±1.03
C组	30	62.1± 5.9	9/21	7（21.2）	26.0±4.1	4.54±1.06	2.84±0.87	1.59±0.37	1.77±1.05
F（χ²）值		1.659	14.02	1.270^a	0.862	1.131	0.809	2.277	0.109
P值		0.195	0.001	0.530	0.425	0.326	0.448	0.108	0.897
组别	Glu （mmol/L）	WBC （×10⁹/L）	HR （次/min）	高血压〔例（%）〕	糖尿病〔例（%）〕	LVEF （%）	收缩压（mmHg）	舒张压（mmHg）
A组	7.08±2.59	6.75±1.73	76±13	38（51.4）	19（38.0）	64.38±5.83	134±20	81±10
B组	7.83±3.70	6.85±1.69	76±13	23（31.1）	14（46.6）	61.10±7.33	129±19	74±14
C组	6.11±2.20	5.98±1.25	81±16	13（17.6）	8（26.7）	65.10±4.77	131±20	82±14
F（χ²）值	2.764	2.943	1.486	10.74^a	0.688^a	3.916	0.499	3.694
P值	0.068	0.057	0.231	0.005	0.335	0.023	0.690	0.028

组别	例数	Egr3	IL-6
A组	50	1 587.74±889.96^a	43.05±18.76^b
B组	30	1 942.59±1 100.37^a	51.43±15.09^a
C组	30	1 116.11±624.56	39.65±15.47
F值		6.490	3.661
P值		0.002	0.023