Abstract: 　Background　At present，the severity of coronary artery lesions is mainly assessed by invasive coronary angiography-based SYNTAX score，and it is hard to predict slow flow during PCI.Finding a biomarker to accurately predict high-risk coronary lesions and the occurrence of slow flow has become one of the hot spots in cardiovascular research.Objective　The present study is an analysis of the relationship of serum Adropin level with the severity of coronary artery disease （CAD） as well as slow flow during PCI in patients with non-ST-elevation acute coronary syndrome （NSTE-ACS）.Methods　A total of 280 participants，240 with NSTE-ACS underwent PCI and 40 individuals with normal coronary angiography （control group） were prospectively enrolled during March 2016 to June 2018.According to the SYNTAX score，patients with NSTE-ACS were divided to high-risk subgroup （SYNTAX score≥33），medium-risk subgroup （22<SYNTAX score<33），and low-risk subgroup （SYNTAX score ≤ 22）.The clinical data and serum Adropin level of all participants were collected.Univariate and multivariate regression analyses were performed to assess the relationship between Adropin level and SYNTAX score.ROC curve analysis of Adropin was carried out to explore its value in predicting high SYNTAX score（≥33） in NSTE-ACS patients.The corrected TIMI frame count （CTFC） was calculated for patients with slow flow during PCI，and the relationship between Adropin and CTFC was analyzed by Pearson correlation analysis.Results　The serum Adropin level differed significantly across three subgroups of NSTE-ACS〔high-risk subgroup （2 357±821）ng/L，medium-risk subgroup （2 899±756）ng/L，and low-risk subgroup （3 177
±913）ng/L〕，and the control group 〔（3 688±966）ng/L〕（P<0.001）.Pearson correlation analysis showed that the serum Adropin level was negatively correlated with SYNTAX score（r=-0.701，P<0.001）.Multivariate Logistic regression analysis showed that low serum Adropin level was an independent predictor of high SYNTAX score（≥33） in NSTE-ACS patients〔OR=0.999，95%CI（0.998，1.000），P=0.007〕.The serum Adropin cut-off value at admission for predicting high SYNTAX score （≥33） based on ROC curve analysis was determined to be 2 295 ng/L，with a sensitivity of 84.4% and a specificity of 92.5%〔AUC=0.958，95%CI（0.936，0.980）〕.38 patients （15.8%） suffered from slow flow during PCI and had a lower mean Adropin level compared with control group （P=0.002）.Pearson correlation analysis showed that the serum Adropin level was negatively correlated with CTFC（r=-0.796，P<0.001）.Conclusion　In patients with NSTE-ACS，serum Adropin level is negatively correlated with SYNTAX score.Low serum Adropin can predict high risk NSTE-ACS patients.Slow flow is more likely to occur in NSTE-ACS patient with lower serum Adropin level during PCI.

Key words: Acute coronary syndrome, Adropin, SYNTAX score, Slow flow, PCI, Correlation analysis, Sensitivity, Specificity

摘要： 背景　目前，冠状动脉病变的严重程度主要根据有创的SYNTAX评分进行评估，经皮冠状动脉介入治疗（PCI）术中是否出现慢血流更是难以预测。能否在无创的前提下找到一种生物标志物来准确预测高危冠状动脉病变及慢血流现象的发生，已经成为心血管研究热点之一。目的　评价急性非ST段抬高型急性冠脉综合征（NSTE-ACS）患者血清Adropin与冠状动脉病变严重程度及PCI术中出现慢血流的关系。方法　选取2016年3月—2018年6月广州医科大学附属第三医院因NSTE-ACS入院行PCI术患者240例，另选取同期心内科40例冠状动脉造影正常者作为对照组。NSTE-ACS患者进行SYNTAX评分，根据SYNTAX评分分为：高危组（SYNTAX≥33分）、中危组（22分<SYNTAX<33分）和低危组（SYNTAX≤22分）。收集所有研究对象临床资料，并测定血清Adropin水平。采用单因素及多因素Logistic回归分析血清Adropin与SYNTAX评分的关系，并绘制受试者工作特征（ROC）曲线分析血清Adropin水平对SYNTAX评分≥33分的NSTE-ACS患者的预测价值。计算PCI术中慢血流患者的校正的TIMI帧数计数（CTFC），采用Pearson相关分析血清Adropin与CTFC的关系。结果　高危组血清Adropin水平为（2 357±821）ng/L，中危组为（2 899±756）ng/L，低危组为（3 177±913）ng/L，对照组为（3 688±966）ng/L，四组血清Adropin水平比较，差异有统计学意义（P<0.001）。Pearson相关分析结果显示，血清Adropin水平与SYNTAX评分呈负相关（r=-0.701，P<0.001）。多因素Logistic回归分析结果显示，低血清Adropin水平是NSTE-ACS患者高SYNTAX评分（≥33分）的独立预测因子〔OR=0.999，95%CI（0.998，1.000），P=0.007〕。血清Adropin预测SYNTAX评分≥33分的NSTE-ACS患者的ROC曲线下面积（AUC）为0.958〔95%CI（0.936，0.980）〕，截断值为2 295 ng/L，灵敏度为84.4%，特异度为92.5%。38例（15.8%）患者在PCI术中出现慢血流。慢血流患者血清Adropin水平低于对照组（P=0.002）。Pearson相关性分析结果显示，慢血流患者血清Adropin水平与CTFC呈负相关（r=-0.796，P<0.001）。结论　在NSTE-ACS患者中，血清Adropin水平与SYNTAX评分呈负相关。低血清水平Adropin可预测高危NSTE-ACS患者，且低血清Adropin水平的NSTE-ACS患者PCI术中可能更易出现慢血流。

关键词: 急性冠脉综合征, Adropin, SYNTAX评分, 慢血流, 经皮冠状动脉介入治疗, 相关性分析, 灵敏度, 特异度