Acute coronary syndrome (ACS) represents a common cardiovascular disease that poses a significant threat to human health, with severe coronary artery lesions and myocardial fibrosis affecting patient prognosis. The use of non-invasive serological markers to assess the severity of coronary artery lesions and myocardial fibrosis can aid in the early risk stratification and management of ACS patients.

This study aimed to explore the relationship between serum levels of complement C1q/tumor necrosis factor-related protein-5 (CTRP5) and the severity of coronary artery lesions, as well as myocardial fibrosis markers in ACS patients, to provide guidance for the clinical assessment of coronary artery lesion severity and myocardial fibrosis.

A total of 184 patients with obstructive stenosis admitted to the Department of Cardiology, Hengshui People's Hospital from February 2021 to February 2022 were selected, along with 100 ACS patients without significant obstructive stenosis undergoing coronary angiography in the same period as controls. General patient data were collected, Doppler echocardiograms were performed, and serum levels of CTRP5, procollagen type Ⅰ (PC Ⅰ), and procollagen type Ⅲ (PC Ⅲ) were measured. The patients with obstructive stenosis were divided into unstable angina (UA) group (n=67), ST-segment elevation myocardial infarction (STEMI) group (n=57), and non-ST-segment elevation myocardial infarction (NSTEMI) group (n=61) ; based on the number of coronary artery lesions, they were categorized into single-vessel disease group (n=42), double-vessel disease group (n=69), and triple-vessel disease group (n=73). According to the SYNTAXⅡ score, they were classified into low-risk (n=77), intermediate-risk (n=73), and high-risk (n=34) groups. Based on the median levels of PCⅠ, patients were divided into low PCⅠ level group (n=95) and high PC I level group (n=89) ; similarly, based on PCⅢ median levels, into low PCⅢ level group (n=93) and high PCⅢ level group (n=91). Multiuariate Logistic regression analysis was used to explore the influencing factors of coronary artery lesion severity. Receiver operating characteristic (ROC) curves were drawn to analyze the diagnostic value of serum CTRP5 for coronary artery lesion severity.

In ACS patients, white blood cell count, neutrophil count, neutrophil-to-lymphocyte ratio, fasting blood glucose (FBG), high-sensitivity cardiac troponin Ⅰ, serum CTRP5, hypersensitive C-reactive protein (hs-CRP), PC Ⅰ, and PC Ⅲ levels were higher than in control patients (P<0.05). Serum CTRP5 and hs-CRP levels in the NSTEMI and STEMI groups were higher than in the UA group (P<0.05). The triple-vessel disease group had higher serum CTRP5, PC Ⅰ, PC Ⅲ, and hs-CRP levels than the single-vessel and double-vessel disease groups (P<0.05). High-risk group patients had higher serum CTRP5, PCⅠ, PCⅢ, and hs-CRP levels compared to low-risk and intermediate-risk groups (P<0.05). The high PC I level group had higher serum CTRP5 and hs-CRP levels compared to the low PC Ⅰ level group (P<0.05). The high PC Ⅲ level group had higher serum CTRP5 and hs-CRP levels compared to the low PC Ⅲ level group (P<0.05). Multivariate Logistic regression analysis showed that increased levels of FBG, hs-CRP, and CTRP5 were risk factors for multivessel coronary artery disease (P<0.05). The areas under the ROC curve (AUC) for predicting multivessel coronary artery disease by serum CTRP5, hs-CRP, and FBG were 0.736 (95%CI=0.678-0.794), 0.687 (95%CI=0.625-0.748), and 0.649 (95%CI=0.585-0.713), respectively.

Serum CTRP5 levels have good predictive value for the severity of coronary artery lesions in ACS patients, and elevated levels of CTRP5 are potentially associated with the occurrence of myocardial fibrosis.

急性冠脉综合征（ACS）是威胁人类健康的常见心血管疾病，严重的冠状动脉病变及心肌纤维化影响患者预后。应用无创血清学指标评估冠状动脉病变程度和心肌纤维化有助于ACS患者早期危险分层及治疗管理。

探讨ACS患者血清补体C1q/肿瘤坏死因子相关蛋白5（CTRP5）水平与冠状动脉病变程度、心肌纤维化相关蛋白指标的关系，为临床判断冠状动脉病变程度和心肌纤维化提供指导。

选取2021年2月—2022年2月在衡水市人民医院心血管内科住院阻塞性狭窄的ACS患者184例，另选取同期行冠状动脉造影未见明显阻塞性狭窄的100例ACS患者作为对照。收集患者一般资料，行多普勒超声心动图检查，测定血清CTRP5、Ⅰ型前胶原（PC Ⅰ）、Ⅲ型前胶原（PC Ⅲ）。将阻塞性狭窄的ACS患者按照临床诊断标准分为不稳定型心绞痛（UA）组（n=67）、ST段抬高型心肌梗死（STEMI）组（n=57）和非ST段抬高型心肌梗死（NSTEMI）组（n=61）；根据冠状动脉造影病变支数分为单支病变组（n=42）、双支病变组（n=69）和三支病变组（n=73）。根据SYNTAX Ⅱ评分标准分为低危组（n=77）、中危组（n=73）和高危组（n=34）。根据PC Ⅰ中位数分为低PC Ⅰ水平组（n=95）和高PC Ⅰ水平组（n=89），依据PC Ⅲ中位数分为低PC Ⅲ水平组（n=93）、高PC Ⅲ水平组（n=91）。采用多因素Logistic回归分析探究冠状动脉病变程度的影响因素。绘制受试者工作特征（ROC）曲线分析血清CTRP5对冠状动脉病变程度的诊断价值。

ACS患者白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞比值、空腹血糖（FBG）、超敏肌钙蛋白I、血清CTRP5、超敏C反应蛋白（hs-CRP）、PC Ⅰ、PC Ⅲ水平高于对照患者（P<0.05）。NSTEMI组、STEMI组患者血清CTRP5、hs-CRP高于UA组（P<0.05）。三支病变组患者血清CTRP5、PC Ⅰ、PC Ⅲ、hs-CRP水平高于单支病变组、双支病变组（P<0.05）。高危组患者血清CTRP5、PC Ⅰ、PC Ⅲ、hs-CRP水平高于低危组、中危组（P<0.05）。高PC Ⅰ水平组血清CTRP、hs-CRP水平高于低PC Ⅰ水平组（P<0.05）。高PC Ⅲ水平组血清CTRP、hs-CRP水平高于低PC Ⅲ水平组（P<0.05）。多因素Logistic回归分析结果显示，FBG、hs-CRP和CTRP5升高是冠状动脉多支病变的危险因素（P<0.05）。血清CTRP5、hs-CRP、FBG预测冠状动脉多支病变的ROC曲线下面积（AUC）分别为0.736（95%CI=0.678~0.794）、0.687（95%CI=0.625~0.748）、0.649（95%CI=0.585~0.713）。

血清CTRP5水平对ACS患者冠状动脉病变程度具有较好的预测价值，且CTRP5水平升高与心肌纤维化的发生可能存在关联。