目的:探讨CHA 2DS 2-Vasc评分联合血清维蛋白原和白蛋白比值(fibrinogen to albumin ratio, FAR)对冠心病(coronary heart disease, CHD)的诊断价值。方法:纳入2017/01/01~2019/01/01期间于安徽医科大学第二附属医院老年心血管内科行冠脉造影术(coronary angiography, CAG)检查的患者185例,其中明确诊断为冠心病116例,非冠心病69例。收集患者的临床资料,所有患者计算FAR值,评估CHA 2DS 2-Vasc评分。以发生冠心病为因变量,年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA 2DS 2-Vasc评分作为自变量建立logistic回归模型,采用受试者工作特征曲线(receiver operating curve, ROC)评估CHA 2DS 2-Vasc评分联合FAR对冠心病的诊断价值。结果:两组年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA 2DS 2-Vasc评分差异有统计学意义(P < 0.05)。多因素logistic回归分析显示CHA 2DS 2-Vasc评分及FAR与CHD的发生呈独立正相联(P < 0.01)。应用ROC曲线评估CHA 2DS 2-Vasc评分、FAR单项及联合诊断的效能,结果显示CHA 2DS 2-Vasc评分的曲线下面积(area under curve, AUC)为0.656 (95% CI 0.575~0.736),P < 0.001,其敏感度60.3%,特异性63.8%,cut-off值1.5;FAR的AUC为0.602 (95% CI 0.521~0.684),敏感度36.2%,特异性85.5%,cut-off值0.075;CHA 2DS 2-Vasc评分联合FAR的AUC为0.702 (95% CI 0.624~0.780),敏感度79.3%,特异性52.2%,cut-off值0.552。结论:与CHA 2DS 2-Vasc评分及FAR相比,CHA 2DS 2-Vasc联合血清FAR对患者发生冠心病具有更好的临床评估价值。 Objective: To explore the value of CHA 2 DS 2-Vasc score combined with serum Fibrinogen-to-Albumin Ratio (FAR) in the diagnosis of coronary heart disease (CHD). Methods: 185 patients who underwent coronary angiography (CAG) in the Department of Geriatric Cardiology at the Second Affiliated Hos-pital of Anhui Medical University from 2017/01/01 to 2019/01/01 were included. Among them, 116 patients were diagnosed with coronary heart disease, 69 patients without coronary heart dis-ease. Clinical data were collected from patients, and all patients were calculated for FAR values to assess CHA 2 DS 2-Vasc scores. A logistic regression model was established with the occurrence of cor-onary heart disease as the dependent variable, age, hypertension, diabetes, Fib, FAR, fasting blood glucose and CHA 2 DS 2-Vasc score as independent variables, and the receiver operating curve (ROC) was used to evaluate the diagnostic value of CHA 2 DS 2-Vasc score combined with FAR for coronary heart disease. Results: There were significant differences in age, hypertension, diabetes, Fib, FAR, fasting blood glucose and CHA 2 DS 2-Vasc scores between the two groups (P < 0.05). Multivariate lo-gistic regression analysis showed that CHA 2 DS 2-Vasc scores and the occurrence of FAR and CHD were independently positively correlated (P < 0.01). The ROC curve was used to evaluate the value of CHA 2 DS 2-Vasc scores, FAR and CHA 2 DS 2-Vasc-FAR score for diagnosis of CHD. The area under curve (AUC) of CHA 2 DS 2-Vasc scores were 0.656 (95% CI 0.575~0.736, P < 0.001), its sensitivity was 60.3%, specificity was 63.8%, cut-off value was 1.5; The AUC of FAR was 0.602 (95% CI 0.521~0.684), sen-sitivity 36.2%, specificity 85.5%, cut-off value 0.075; The AUC of CHA 2 DS 2-Vasc score combined with FAR was 0.702 (95% CI 0.624~0.780), sensitivity 79.3%, specificity 52.2%, cut-off value 0.552. Con-clusion: Compared with CHA 2 DS 2-Vasc and FAR, CHA2DS2-Vasc combined with serum FAR has better clinical evaluation value for coronary heart disease in patients.
目的:探讨CHA2DS2-Vasc评分联合血清维蛋白原和白蛋白比值(fibrinogen to albumin ratio, FAR)对冠心病(coronary heart disease, CHD)的诊断价值。方法:纳入2017/01/01~2019/01/01期间于安徽医科大学第二附属医院老年心血管内科行冠脉造影术(coronary angiography, CAG)检查的患者185例,其中明确诊断为冠心病116例,非冠心病69例。收集患者的临床资料,所有患者计算FAR值,评估CHA2DS2-Vasc评分。以发生冠心病为因变量,年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA2DS2-Vasc评分作为自变量建立logistic回归模型,采用受试者工作特征曲线(receiver operating curve, ROC)评估CHA2DS2-Vasc评分联合FAR对冠心病的诊断价值。结果:两组年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA2DS2-Vasc评分差异有统计学意义(P < 0.05)。多因素logistic回归分析显示CHA2DS2-Vasc评分及FAR与CHD的发生呈独立正相联(P < 0.01)。应用ROC曲线评估CHA2DS2-Vasc评分、FAR单项及联合诊断的效能,结果显示CHA2DS2-Vasc评分的曲线下面积(area under curve, AUC)为0.656 (95% CI 0.575~0.736),P < 0.001,其敏感度60.3%,特异性63.8%,cut-off值1.5;FAR的AUC为0.602 (95% CI 0.521~0.684),敏感度36.2%,特异性85.5%,cut-off值0.075;CHA2DS2-Vasc评分联合FAR的AUC为0.702 (95% CI 0.624~0.780),敏感度79.3%,特异性52.2%,cut-off值0.552。结论:与CHA2DS2-Vasc评分及FAR相比,CHA2DS2-Vasc联合血清FAR对患者发生冠心病具有更好的临床评估价值。
冠心病,冠状动脉造影术,CHA2DS2-Vasc,纤维蛋白/白蛋白比值
Zequn Wu, Jingjing Zhang, Hualiang Zhu, Chandong Ding*
Cardiovascular Department for Gerontism, NO. 2 Affiliated Hospital of Anhui Medical University, Hefei Anhui
Received: Dec. 28th, 2022; accepted: Jan. 21st, 2023; published: Jan. 31st, 2023
Objective: To explore the value of CHA2DS2-Vasc score combined with serum Fibrinogen-to-Albumin Ratio (FAR) in the diagnosis of coronary heart disease (CHD). Methods: 185 patients who underwent coronary angiography (CAG) in the Department of Geriatric Cardiology at the Second Affiliated Hospital of Anhui Medical University from 2017/01/01 to 2019/01/01 were included. Among them, 116 patients were diagnosed with coronary heart disease, 69 patients without coronary heart disease. Clinical data were collected from patients, and all patients were calculated for FAR values to assess CHA2DS2-Vasc scores. A logistic regression model was established with the occurrence of coronary heart disease as the dependent variable, age, hypertension, diabetes, Fib, FAR, fasting blood glucose and CHA2DS2-Vasc score as independent variables, and the receiver operating curve (ROC) was used to evaluate the diagnostic value of CHA2DS2-Vasc score combined with FAR for coronary heart disease. Results: There were significant differences in age, hypertension, diabetes, Fib, FAR, fasting blood glucose and CHA2DS2-Vasc scores between the two groups (P < 0.05). Multivariate logistic regression analysis showed that CHA2DS2-Vasc scores and the occurrence of FAR and CHD were independently positively correlated (P < 0.01). The ROC curve was used to evaluate the value of CHA2DS2-Vasc scores, FAR and CHA2DS2-Vasc-FAR score for diagnosis of CHD. The area under curve (AUC) of CHA2DS2-Vasc scores were 0.656 (95% CI 0.575~0.736, P < 0.001), its sensitivity was 60.3%, specificity was 63.8%, cut-off value was 1.5; The AUC of FAR was 0.602 (95% CI 0.521~0.684), sensitivity 36.2%, specificity 85.5%, cut-off value 0.075; The AUC of CHA2DS2-Vasc score combined with FAR was 0.702 (95% CI 0.624~0.780), sensitivity 79.3%, specificity 52.2%, cut-off value 0.552. Conclusion: Compared with CHA2DS2-Vasc and FAR, CHA2DS2-Vasc combined with serum FAR has better clinical evaluation value for coronary heart disease in patients.
Keywords:Coronary Heart Disease, Coronary Angigraphy, CHA2DS2-Vasc Score, Fibrinogen/Albumin Ratio (FAR)
Copyright © 2023 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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纤维蛋白原/白蛋白比值(fibrinogen/albumin ratio, FAR)涉及到纤维蛋白原(fibrinogen, Fib)和白蛋白(albumin, Alb)两个实验室指标,Fib和Alb既参与炎症反应,又参与凝血途径,Fib可通过核因子转录途径介导促炎因子的合成,参与炎症的发生发展,还可以通过与血小板表面糖蛋白受体结合促进血小板聚集。Alb是负性炎症蛋白,且与红细胞聚集负相关。有研究表明,FAR对冠状动脉的病变程度有预测作用 [
纳入2017/01/01~2019/01/01在安徽医科大第二附属医院老年心血管内科就诊且行CAG检查的患者,排除自身免疫性疾病、严重慢性肝肾功能不全疾病、恶性肿瘤的患者,共316例。根据冠脉造影的结果,将有1支或1支以上主要冠状动脉(直径 > 2.0 mm)血管狭窄 ≥ 50%的患者纳入冠心病组(CHD组),共116例,无明显冠状动脉粥样硬化征象或主要冠状动脉血管狭窄程度 < 50%的患者纳入非冠心病组(N-CHD组),共69例。
记录所有入选患者基线资料,完善病史记录,同时评估患者入院时CHA2DS2-Vasc评分。CHA2DS2-Vasc评分总分0~9分,其评分项目包含年龄 ≥ 75岁及脑卒中(包括中风、短暂性脑缺血发作、血栓栓塞病史)为2分;年龄范围65~74岁、女性、充血性心力衰竭或左室功能障碍、高血压、糖尿病及血管疾病(包括心肌梗死病史或外周动脉疾病或主动脉粥样硬化病史)均为1分。
入院后第二天空腹抽取血标本,收集空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血肌酐、纤维蛋白原等化验结果。
通过桡动脉或股动脉行CAG术(飞利浦FD20平板血管造影机),以Judkins标准法采集图像,并留取左冠状动脉主干、左前降支、左回旋支、右冠状动脉及其主要分支的血管影像,由两位专业的心内科医师判定血管狭窄程度。
采用SPSS 23软件行数据分析,计量资料(正态分布)采用均数 ± 标准差( x ¯ ± s )表示,组间比较采用t检验,计量资料(正态分布)以中位数(Median, M)、四分位间距(Interquartile Range, IQR)表示,组间比较采用Mann-Whitney U秩和检验,计数资料以频数和百分率(%)表示,组间比较采用χ2检验。采用多因素logistic回归分析,以年龄、高血压、糖尿病、Fib、FAR、空腹血糖、及作为CHA2DS2-Vasc评分为自变量,以是否患有冠心病为因变量,评估冠心病发生的影响因素。采用受试者工作特征曲线(receiver operating curve, ROC)评价CHA2DS2-Vasc评分、FAR及CHA2DS2-Vasc-FAR评分对冠心病的诊断价值,以P < 0.05表示差异具有统计学意义。
结果(表1)显示:两组年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA2DS2-Vasc评分差异有统计学意义(P < 0.05)。两组性别、吸烟、肌酐、胆固醇、甘油三酯、高密度脂蛋白及低密度脂蛋白等方面差异均无统计学意义(P > 0.05)。
项目 | 非冠心病组(69例) | 冠心病组(116例) | P值 |
---|---|---|---|
年龄(岁) | 58.14 ± 10.16 | 63.49 ± 10.15b | 0.001 |
男性[例数(%)] | 24 (34.8) | 44 (37.9) | 0.668 |
吸烟[例数(%)] | 53 (76.8) | 82 (70.7) | 0.068 |
高血压[例数(%)] | 33 (47.8) | 74 (63.8)a | 0.033 |
糖尿病[例数(%)] | 11 (15.9) | 52 (44.8)b | < 0.001 |
Fib (mg/L) | 2.30 (2.14, 2.88) | 2.61 (2.26, 3.03)a | 0.025 |
FAR | 6 (5, 7) | 7 (5, 8)a | 0.018 |
CHA2DS2-Vasc评分 | 1 (0.5, 2) | 2 (1, 3)b | < 0.001 |
肌酐(μmol/L) | 71.91 ± 19.33 | 77.16 ± 16.12 | 0.06 |
空腹血糖(mmol/l) | 5.18 (4.88, 5.49) | 5.37 (4.91, 6.24)a | 0.049 |
胆固醇(mmol/l) | 4.60 (3.81, 5.29) | 4.46 (3.52, 5.21) | 0.234 |
甘油三酯(mmol/l) | 1.56 (0.93, 2.38) | 1.44 (1.00, 2.00) | 0.680 |
高密度脂蛋白(mmol/l) | 1.10 (0.95, 1.38) | 1.07 (0.92, 1.25) | 0.179 |
低密度脂蛋白(mmol/l) | 2.90 ± 0.70 | 2.77 ± 0.87 | 0.247 |
表1. 基线资料及生化指标比较
与非冠心病组比较:aP < 0.05,bP < 0.01。
如表2所示:以CHD为因变量,年龄、高血压、糖尿病、Fib、FAR、空腹血糖及CHA2DS2-Vasc评分自变量,进行二分类多因素logistic回归分析,变量筛选采用逐步向前法(forward stepwise),结果显示CHA2DS2-Vasc评分及FAR与CHD的发生呈独立正相联(P < 0.05)。
变量 | B | SE | Wald χ2值 | OR值 | P值 | 95% CI |
---|---|---|---|---|---|---|
CHA2DS2-Vasc | 0.462 | 0.140 | 10.798 | 1.587 | 0.001 | 1.205~2.090 |
FAR | 0.227 | 0.091 | 6.236 | 1.254 | 0.013 | 1.050~1.498 |
表2. 冠心病患者的多因素logistic回归分析
分别以CHA2DS2-Vasc评分、FAR作为独立指标变量,结果(表3)显示CHA2DS2-Vasc评分的曲线下面积(area under curve, AUC)为0.656 (95% CI 0.575~0.736),P < 0.001,其敏感度60.3%,特异性63.8%,cut-off值1.5,约登指数0.241;FAR的AUC为0.602 (95% CI 0.521~0.684),敏感度36.2%,特异性85.5%,cut-off值0.075,约登指数0.217;CHA2DS2-Vasc评分联合FAR的AUC为0.702 (95% CI 0.624~0.780),敏感度79.3%,特异性52.2%,cut-off值0.552,约登指数0.315。见图1。由此可见联合诊断模型优于单一指标的诊断效能。
变量 | 曲线下面积 | P值 | 约登指数 | 敏感度 | 特异性 | 95% CI | |
---|---|---|---|---|---|---|---|
上限 | 下限 | ||||||
CHA2DS2-Vasc评分 | 0.656 | P < 0.001 | 0.241 | 60.3 | 63.8 | 0.575 | 0.736 |
FAR | 0.602 | P < 0.05 | 0.217 | 36.2 | 85.5 | 0.521 | 0.684 |
CHA2DS2-Vasc评分联合FAR | 0.702 | P < 0.001 | 0.315 | 74.1 | 59.4 | 0.624 | 0.780 |
表3. ROC曲线分析
图1. ROC曲线
FAR作为一个新型的生物标志物,近年来国内外多篇文章报道其在冠心病中的重要意义 [
CHA2DS2和CHA2DS2-Vasc评分主要用于房颤卒中风险评估,目前广泛应用于心血管领域,用于预测冠心病的发生,心血管的预后 [
本研究通过多因素logistics回归分析显示,以CHD为因变量,年龄、高血压、糖尿病、Fib、FAR、空腹血糖、及作为CHA2DS2-Vasc评分自变量,进行二分类多因素logistic回归分析,变量筛选采用逐步向前法,结果显示CHA2DS2-Vasc评分及FAR与CHD的发生呈独立正相联(P < 0.05)。分别以CHA2DS2-Vasc评分、FAR作为独立指标变量,结果显示CHA2DS2-Vasc评分的曲线下面积(area under curve, AUC)为0.656 (95% CI 0.575~0.736),P < 0.001,其敏感度60.3%,特异性63.8%,cut-off值1.5,约登指数0.241;FAR的AUC为0.602 (95% CI 0.521~0.684),敏感度36.2%,特异性85.5%,cut-off值0.075,约登指数0.217;CHA2DS2-Vasc评分联合FAR的AUC为0.702 (95% CI 0.624~0.780),敏感度79.3%,特异性52.2%,cut-off值0.552,约登指数0.315。由此可见联合诊断模型优于单一指标的诊断效能。综上所述,本研究表明CHA2DS2-Vasc-FAR评分系统的AUC显著高于常规CHA2DS2-Vasc评分系统,表明CHA2DS2-Vasc-FAR模型评分系统对于诊断CHD更准确。本研究的创新之处在于首次将CHA2DS2-Vasc评分系统与FAR结合来联合诊断CHD,结果表明其提高了CHA2DS2-Vasc评分系统的预测价值。本研究作为一项单中心、回顾性研究,存在一定的局限性,主要表现在:1) 本研究未进行长期的病人随访,因此并未观察CHA2DS2-Vasc评分联合FAR对CHD的长期诊断价值;2) 本研究为单中心、小样本量的回顾性研究,代表性有限,可能存在偏差。所以,在未来的研究中,需要多中心、大样本量、更完善的前瞻性研究才能进一步证实结论。
本研究已获得所有患者的知情同意。
吴泽群,张晶晶,朱华良,丁旵东. CHA2DS2-Vasc评分联合血清FAR在冠心病中的诊断价值Diagnostic Value of CHA2DS2-Vasc Score Combined with Serum Fibrinogen-to-Albumin Ratio in Coronary Heart Disease[J]. 临床医学进展, 2023, 13(01): 1139-1145. https://doi.org/10.12677/ACM.2023.131157