血清MG53水平与冠状动脉钙化的相关性研究

doi:10.16138/j.1673-6087.2024.05.03

摘要/Abstract

摘要：

目的： 研究血清MG53水平与冠状动脉钙化（coronary artery calcification，CAC）严重程度及患者预后的相关性。方法： 纳入2016—2018年因胸闷等不适入住上海交通大学医学院附属瑞金医院心血管内科治疗，经冠状动脉CT血管成像（CT angiography，CTA）检查确诊存在CAC的患者。使用Agatston积分计算CAC评分（CAC score, CACS），使用酶联免疫吸附法检测血清MG53水平，并对患者进行为期5年的随访，记录心血管终点事件发生情况。根据CACS和血清MG53水平对患者进行分组。使用Logistic回归分析血清MG53水平与患者CAC水平的相关性；使用Kaplan-Meier曲线和COX比例风险模型分析血清MG53水平对CAC患者预后的影响。使用R软件（4.2.2版）计算血清MG53水平预测终点事件的最佳截断值。结果： 共纳入患者195例。与低风险组相比，高风险组患者的血清MG53水平明显降低[57.717（28.548，139.965）pg/mL比33.553（13.509，56.952） pg/mL，P<0.001]。血清MG53水平与CAC病变程度独立相关（OR=0.984，95%CI：0.971~0.994，P<0.007)。低MG53水平患者心血管事件的发生风险显著升高（OR=0.282，95%CI：0.160~0.498，P<0.001）。血清MG53水平的最佳截断值为18.36 pg/mL。结论： 血清MG53水平可能与CAC的严重程度以及患者预后相关，提示血清MG53水平可能是预测CAC及患者预后的生物标志物。

关键词: 冠状动脉钙化, MG53, 冠状动脉钙化评分, 生物标志物, 预后, CT血管成像

Abstract:

Objective To study the correlation between serum MG53 level and coronary artery calcification (CAC), and the correlation between serum MG53 level and the prognosis of patients with CAC. Methods A total of 195 patients admitted to the Department of Cardiovascular Medicine of Ruijin Hospital， Shanghai Jiao Tong University School of Medicine from 2016 to 2018 due to chest distress and other discomforts were selected. CAC was confirmed by coronary CT angiography (CTA) in all patients. Agatston integral was used to calculate CAC score, and serum MG53 level was detected by enzyme-linked immunosorbent assay. Patients were followed up for 5 years, and the endpoint events were recorded. Patients were grouped according to CAC score and serum MG53 level. Logistic regression was used to analyze the correlation between serum MG53 level and CAC level. Kaplan-Meier curve and COX proportional risk model were used to analyze the effect of serum MG53 level on the prognosis of CAC patients. The R software (4.2.2 version) was used to calculate the best cut-off value of serum MG53 level for predicting end-point events. Results Compared with the low-risk group，the serum MG53 level in the high-risk group was significantly lower [57.717 (28.548，139.965) pg/mL vs 33.553 (13.509，56.952) pg/mL, P<0.001]. Serum MG53 level was independently associated with the severity of CAC (OR=0.984, 95%CI：0.971-0.994, P<0.007). The risk of cardiovascular events was significantly increased in patients with low MG53 levels (OR=0.282, 95%CI：0.160-0.498, P<0.001). The cutoff value of MG53 was calculated as 18.36 pg/mL. Conclusions Serum MG53 level may be related to the degree of CAC and the prognosis of patients，suggesting that serum MG53 level may be a biomarker for predicting CAC and the prognosis of patients.

Key words: Coronary artery calcification, MG53, Coronary artery calcium score, Biomarkers, Prognosis, CT angiography

中图分类号:

R543.3

张煜, 查晴, 杨玲, 叶佳雯, 杨克, 刘艳. 血清MG53水平与冠状动脉钙化的相关性研究[J]. 内科理论与实践, 2024, 19(05): 303-309.

ZHANG Yu, ZHA Qing, YANG Ling, YE Jiawen, YANG Ke, LIU Yan. Study on the correlation between serum MG53 level and coronary artery calcification[J]. Journal of Internal Medicine Concepts & Practice, 2024, 19(05): 303-309.

图/表 8

表1

2组患者的基线资料[$\bar{x}\pm s$/n(%)/M(Q1, Q3)]

项目	低风险组 (n=66)	高风险组 (n=129)	t/U/χ²	P
年龄(岁)	59.00(53.00,66.00)	67.00(61.00,75.00)	-4.889	<0.001
男性[n(%)]	39(59.1)	99(76.7)	6.578	0.010
BMI(kg/m²)	25.403±3.218	25.421±3.235	-0.036	0.972
吸烟[n(%)]	24(36.4)	69(53.5)	5.133	0.023
心率（次/min）	78(68,88)	76(70,84)	0.263	0.794
收缩压(mmHg)	130.606±17.203	135.341±19.581	-1.655	0.100
舒张压(mmHg)	73.591±10.047	74.829±10.861	-0.769	0.443
高血压[n(%)]	36(54.5)	94(72.9)	6.596	0.010
糖尿病[n(%)]	16(24.2)	50(38.8)	4.110	0.043
慢性肾脏病[n(%)]	1(1.5)	6(4.7)	1.241	0.265
hsCRP（mg/L）	3.689±9.875	2.591±6.299	0.774	0.440
血红蛋白（g/L）	136.0(124.0,144.0)	135.0(124.0,145.0)	0.361	0.719
血小板（×10⁹/L）	177.0(146.0,205.0)	172.0(145.0,206.0)	0.043	0.967
空腹血糖（mmol/L）	5.506±1.296	5.943±2.073	-1.411	0.160
HbA_1c（%）	5.911±0.774	6.339±1.220	-2.508	0.013
TC(mmol/L)	3.66(3.02,4.18)	4.20(3.66,5.28)	-4.362	<0.001
TG(mmol/L)	1.32(1.00,1.74)	1.42(1.04,1.99)	-1.243	0.214
LDL-C（mmol/L）	2.03(1.49,2.46)	2.67(2.17,3.44)	-5.740	<0.001
HDL-C（mmol/L）	1.37(1.22,1.51)	1.09(0.93,1.29)	6.544	<0.001
LP(a)（mmol/L）	0.12(0.07,0.32)	0.14(0.08,0.30)	-0.236	0.814
eGFR(ml/min)	85.203±17.008	78.278±17.753	2.578	0.010
Ca²⁺(mmol/L)	2.240(2.170,2.290)	2.240(2.170,2.310)	-0.370	0.712
P(mmol/L)	1.140(1.010,1.250)	1.120(1.020,1.230)	0.550	0.583
D-二聚体(mg/L)	0.325±0.382	0.881±3.295	-1.359	0.176
MG53（pg/mL）	58.717(28.548,139.965)	33.553(13.509,56.952)	4.840	<0.001
LVEF(%)	66.00(64.00,69.00)	64.00(57.00,68.00)	3.125	0.002
LVDD(mm)	48.00(46.00,52.00)	49.00(46.00,51.00)	-0.046	0.965
LVSD(mm)	30.00(29.00,33.00)	31.00(29.00,34.00)	-0.719	0.471
他汀类药物[n(%)]	42(63.6)	120(93.0)	26.819	<0.001
抗血小板药[n(%)]	44(66.7)	119(92.2)	20.830	<0.001
CCB[n(%)]	18(27. 3)	46(35.7)	1.393	0.238
利尿剂[n(%)]	28(42.4)	28(21.7)	9.156	0.002
ACEI/ARB[n(%)]	33(50.0)	78(60.5)	1.950	0.163
β受体阻滞剂[n(%)]	51(77.3)	89(69.0)	1.478	0.224
降糖药[n(%)]	11(16.7)	39(30.2)	4.214	0.040

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参考文献 20

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因素	β	SE	Wald χ²	OR（95%CI）	P
年龄(每增加 1岁)	0.068	0.015	20.603	1.070(1.039~1.102)	<0.001
男性	0.826	0.326	6.431	2.285(1.207~4.326)	0.011
目前吸烟	0.699	0.311	5.063	2.012(1.094~3.701)	0.024
高血压	0.806	0.317	6.472	2.238(1.203~4.164)	0.011
糖尿病	0.682	0.339	4.04	1.978(1.017~3.846)	0.044
抗血小板药物使用史	1.783	0.42	18.012	5.950(2.611~13.558)	<0.001
他汀类药物使用史	2.031	0.43	22.297	7.619(3.280~17.699)	<0.001
降糖药使用史	0.773	0.382	4.1	2.167(1.025~4.580)	0.043
HDL-C（每升高 1 mmol/L）	-3.48	0.641	-29.496	0.031(0.009~0.108）	<0.001
LDL-C（每升高 1 mmol/L）	1.051	0.219	22.992	2.859(1.861~4.393）	<0.001
eGFR（每升高 1 mL/min）	-0.023	0.009	-6.325	0.977(0.960~0.995）	0.012
MG53（每升高 1 pg/mL）	-0.015	0.003	-19.448	0.985(0.979~0.992）	<0.001

指标	HR(95% CI)	P
未调整	0.282(0.16~0.498)	<0.001
模型1	0.34(0.191~0.605)	<0.001
模型2	0.4(0.217~0.738)	0.003

指标	CACS≤100 AU		CACS>100 AU
指标	HR(95% CI)	P	HR(95% CI)	P
未调整	0.377 (0.09~1.577)	0.181	0.296 (0.158~0.552)	<0.001
模型1	0.254 (0.052~1.254)	0.093	0.333 (0.175~0.631)	0.001
模型2	0.24 (0.02~2.822)	0.257	0.369 (0.184~0.739)	0.005