Correlation of Nucleolin with the Stability and Severity of Coronary Plaque in Acute Coronary Syndrome

doi:10.12114/j.issn.1007-9572.2023.0870

Abstract

Abstract:

Background

Acute coronary syndrome (ACS) is a group of pathological clinical syndromes characterized with coronary atherosclerotic plaque rupture or erosion, and secondary complete or incomplete occlusion of thrombosis. The selection of specific and sensitive serological markers and detection methods has an important clinical value for rapid, accurate early diagnosis, assessment, and treatment of ACS.

Objective

To explore the correlation of plasma nucleolin (NCL) with the stability and severity of coronary artery plaques in ACS patients, and to analyze the value of NCL in predicting ACS.

Methods

A total of 117 ACS patients admitted to the Cardiovascular Department of the First Hospital of Changsha in 2022 and examined by coronary angiography were selected as the study subjects, including 36 cases of unstable angina (UA group), 36 cases of non-ST segment elevation myocardial infarction (NSTEMI group), and 45 cases of ST segment elevation myocardial infarction (STEMI group). During the same period, 39 cases of non-ACS patients were selected as the control group. Blood samples and general clinical data were collected. Plasma levels of NCL, C-reactive protein (CRP), and low-density lipoprotein cholesterol (LDL-C) were measured. According to the results of coronary angiography, ACS patients were divided into non-lesion group, single vessel lesion group, double vessel lesion group, and multi-vessel lesion group. ACS patients were further assigned into the vulnerable plaque group and stable plaque group based on the characteristics of ultrasonic echo. Those without atherosclerotic plaque were classified as plaque-free group. The correlation of NCL levels with CRP and LDL-C levels in different groups of ACS patients was evaluated. The correlation of NCL levels with the number of coronary artery lesions, severity of coronary artery lesions, and the Gensini score in ACS patients was identified. Multivariate Logistic regression analysis was used to identify whether plasma NCL was an independent risk factor for ACS. The optimal cut-off value of plasma NCL in predicting ACS was determined by the receiver operating characteristic (ROC) curves.

Results

Plasma NCL levels were positively correlated with LDL-C and CRP (r=0.572, and 0.639, respectively; both P<0.05). Plasma NCL levels were compared in ACS patients with varied degrees of carotid plaque, and they were higher in the vulnerable plaque group (n=73), followed by the stable plaque group (n=49) and plaque-free group (n=33). Plasma NCL was positively correlated with the degree of carotid plaque (r=0.543, P<0.05). Plasma NCL levels in ACS patients were significantly higher in the multi-vessel lesion group (n=39) than the double vessel lesion group (n=49) (P<0.05), while plasma NCL levels were significantly higher in the double vessel lesion group (n=49) than the single vessel lesion group (n=29) (P<0.05). Plasma NCL was positively correlated with the number of diseased coronary vessels in ACS patients (r=0.445, P<0.05). Plasma NCL levels were significantly higher in the high Gensini score group than those of the low Gensini score and medium Gensini score groups (P<0.05), which were positively correlated with the number of diseased coronary vessels (r=0.799, P<0.05). Multivariate Logistic regression analysis showed that increased NCL was an independent risk factor for ACS, with the optimal cut-off value of 0.765 ng/mL in ROC curves.

Conclusion

Plasma NCL levels have a certain clinical significances in evaluating plaque stability, recognizing ACS and risk stratification of ACS patients. Plasma NCL level is positively correlated with the number of coronary artery lesions and Gensini score, serving as a reference indicator for predicting and evaluating the severity of coronary artery lesions to a certain extent. Elevated plasma NCL levels may be an independent risk factor for the occurrence of ACS and have predictive diagnostic value for ACS.

Key words: Nucleolin, Acute coronary syndrome, Patch stability, Degree of coronary artery disease

摘要：

背景

急性冠脉综合征（ACS）是以冠状动脉粥样硬化斑块破裂或糜烂，继发完全或不完全闭塞血栓形成的一组病理性临床综合征。选择特异度和灵敏度高的血清学标志物及检测方法对ACS患者进行快速和准确的早期诊断、评估病情并采取救治措施具有重要的临床价值。

目的

探讨ACS患者血浆核仁素（NCL）水平与ACS患者冠状动脉斑块稳定性、病变程度之间的关系，以及NCL预测ACS的价值。

方法

选取2022年长沙市第一医院心血管内科住院并完成冠状动脉造影的117例患者为研究对象，均符合ACS标准。36例为不稳定性心绞痛（UA组）、36例为非ST段抬高型心肌梗死（NSTEMI组）、45例为ST段抬高型心肌梗死（STEMI组）（以上均视为ACS患者），并选择39例非ACS患者作为对照组。收集患者血样标本及一般临床资料，检测血浆NCL、C反应蛋白（CRP）、低密度脂蛋白胆固醇（LDL-C）水平。根据冠状动脉造影的结果将ACS患者分为无病变组、单支病变组、双支病变组、多支病变组。根据超声回声特征将ACS患者分为易损斑块组和稳定斑块组，未见粥样硬化斑块者为无斑块组。评估NCL水平与ACS患者各组CRP、LDL-C的相关性；分析NCL与ACS患者冠状动脉病变支数、冠状动脉病变严重程度以及Gensini积分的相关性；采用多因素Logistic回归分析血浆NCL是否为ACS的独立影响因素，采用受试者工作特征（ROC）曲线评估NCL预测ACS发生的最佳截断值。

结果

NCL水平与LDL-C、CRP呈正相关（r=0.572、0.639，P<0.05）。比较不同颈动脉斑块病变程度的患者NCL水平，易损斑块组（n=73）>稳定斑块组（n=49）>无斑块组（n=33），NCL水平与颈动脉斑块病变程度呈正相关（r=0.543，P<0.05）。冠状动脉多支病变组（n=39）NCL水平高于双支病变组（n=49）（P<0.05），冠状动脉双支病变组NCL水平均高于单支病变组（n=29）（P<0.05），NCL水平与冠状动脉病变支数呈正相关（r=0.445，P<0.05）；Gensini积分高分组的NCL水平明显高于低分组、中分组（P<0.05），并且冠状动脉病变支数与Gensini积分呈正相关（r=0.799，P<0.05）。多因素Logistic回归分析显示NCL水平升高是ACS的独立危险因素，ROC曲线分析显示NCL最佳截断值为0.765 ng/mL。

结论

血浆NCL水平对ACS患者斑块稳定性评价有一定临床意义，对ACS识别、风险分层预测有一定参考价值。血浆NCL水平与冠状动脉病变支数、Gensini积分均呈正相关，血浆NCL水平在一定程度上可作为预测评估冠状动脉病变严重程度的一项参考指标。血浆NCL水平升高可能是ACS发生的独立危险因素，并对ACS有预测诊断价值。

关键词: 核仁素, 急性冠脉综合征, 斑块稳定性, 冠脉病变程度

CLC Number:

R 542.2

ZHANG Qiongdan,MAO Zhuoni,HUANG Dan, et al. Correlation of Nucleolin with the Stability and Severity of Coronary Plaque in Acute Coronary Syndrome[J]. Chinese General Practice, 2024, 27(36): 4561-4567. DOI: 10.12114/j.issn.1007-9572.2023.0870.
张琼丹,毛卓尼,黄丹等. 血浆核仁素与急性冠脉综合征冠状动脉斑块稳定性、病变程度的相关性研究[J]. 中国全科医学, 2024, 27(36): 4561-4567. DOI: 10.12114/j.issn.1007-9572.2023.0870.

Figures/Tables 6

References 24

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组别	例数	性别（男/女）	年龄（岁）	高血压病史[例（%）]	糖尿病病史[例（%）]	吸烟史[例（%）]	饮酒史[例（%）]	家族史[例（%）]	NCL （ng/mL）
对照组	39	19/20	64.9±11.7	29（74.4）	11（28.2）	13（33.3）	2（5.13）	2（12.5）	0.93±0.41
UA组	36	14/22	71.8±8.5	19（52.8）	17（47.2）	14（38.9）	5（13.9）	2（12.5）	1.25±0.67
NSTEMI组	36	27/9	66.2±14.4	22（61.1）	9（25）	20（55.6）	11（30.6）	3（18.8）	1.71±0.42
STEMI组	45	25/20	67.7±12.0	23（51.1）	24（53.3）	19（42.2）	13（28.9）	9（56.3）	3.11±0.76
χ²（F）值		10.18	2.38^a	1.37	10.38	4.05	11.01	6.77	75.25^a
P值		0.010	0.072	0.712	0.016	0.256	0.012	0.080	<0.001
组别	ALT （U/L）	Cr （μmoI/L）	血糖（mmol/L）	TC （mmol/L）	TG （mmol/L）	HDL-C （mmol/L）	LDL-C （mmol/L）	CRP （mg/L）	Gensini积分（分）
对照组	17.52±11.08	69.00±22.00	6.84±3.11	4.01±1.30	1.63±1.27	1.14±0.29	1.47±0.55	3.05±1.44	13.50±7.65
UA组	27.32±21.43	66.23±32.51	6.83±2.76	3.94±0.96	1.65±0.89	1.08±0.34	1.96±0.84	8.33±3.17	21.65±8.07
NSTEMI组	34.62±21.48	82.32±38.11	6.11±6.01	4.38±0.99	1.74±1.14	1.02±0.29	2.06±0.91	11.24±2.71	34.69±12.04
STEMI组	41.74±9.63	87.34±24.69	6.51±3.52	3.76±0.81	1.48±0.73	0.98±0.23	3.05±.1.06	12.65±3.44	61.91±23.32
χ²（F）值	1.51^a	4.52^a	0.96^a	2.49^a	0.47^a	2.81^a	24.77^a	91.30^a	86.09^a
P值	0.215	0.005	0.414	0.063	0.703	0.041	<0.001	<0.001	<0.001

组别	例数	性别（男/女）	年龄（岁）	高血压病史[例（%）]	糖尿病病史[例（%）]	吸烟史[例（%）]	饮酒史[例（%）]	家族史[例（%）]	NCL （ng/mL）
对照组	39	19/20	64.9±11.7	29（74.4）	11（28.2）	13（33.3）	2（5.13）	2（12.5）	0.93±0.41
UA组	36	14/22	71.8±8.5	19（52.8）	17（47.2）	14（38.9）	5（13.9）	2（12.5）	1.25±0.67
NSTEMI组	36	27/9	66.2±14.4	22（61.1）	9（25）	20（55.6）	11（30.6）	3（18.8）	1.71±0.42
STEMI组	45	25/20	67.7±12.0	23（51.1）	24（53.3）	19（42.2）	13（28.9）	9（56.3）	3.11±0.76
χ²（F）值		10.18	2.38^a	1.37	10.38	4.05	11.01	6.77	75.25^a
P值		0.010	0.072	0.712	0.016	0.256	0.012	0.080	<0.001
组别	ALT （U/L）	Cr （μmoI/L）	血糖（mmol/L）	TC （mmol/L）	TG （mmol/L）	HDL-C （mmol/L）	LDL-C （mmol/L）	CRP （mg/L）	Gensini积分（分）
对照组	17.52±11.08	69.00±22.00	6.84±3.11	4.01±1.30	1.63±1.27	1.14±0.29	1.47±0.55	3.05±1.44	13.50±7.65
UA组	27.32±21.43	66.23±32.51	6.83±2.76	3.94±0.96	1.65±0.89	1.08±0.34	1.96±0.84	8.33±3.17	21.65±8.07
NSTEMI组	34.62±21.48	82.32±38.11	6.11±6.01	4.38±0.99	1.74±1.14	1.02±0.29	2.06±0.91	11.24±2.71	34.69±12.04
STEMI组	41.74±9.63	87.34±24.69	6.51±3.52	3.76±0.81	1.48±0.73	0.98±0.23	3.05±.1.06	12.65±3.44	61.91±23.32
χ²（F）值	1.51^a	4.52^a	0.96^a	2.49^a	0.47^a	2.81^a	24.77^a	91.30^a	86.09^a
P值	0.215	0.005	0.414	0.063	0.703	0.041	<0.001	<0.001	<0.001

组别	例数	血浆NCL
无斑块组	33	1.37±0.33
稳定斑块组	49	2.06±0.89^a
易损斑块组	73	3.13±0.76^ab
F值		32.605
P值		<0.001

组别	例数	血浆NCL
无斑块组	33	1.37±0.33
稳定斑块组	49	2.06±0.89^a
易损斑块组	73	3.13±0.76^ab
F值		32.605
P值		<0.001

组别	例数	血浆NCL
轻度冠状动脉狭窄组	31	1.12±0.42
中度冠状动脉狭窄组	52	2.01±0.91^a
重度冠状动脉狭窄组	34	2.89±0.93^ab
F值		23.701
P值		<0.001