标题：稳定型心绞痛患者血清Angpt2/Angpt1比值与急性心肌梗死发生风险的相关性

      作者：秦建宁，丁辉    西北大学附属医院·西安市第三医院心血管内科，陕西 西安 710016

      卷次： 2019年30卷22期

      【摘要】 目的 探讨稳定型心绞痛(SAP)患者血清血管生成素-2 (Angpt2)/血管生成素-1 (Angpt1)比值与急性心肌梗死(AMI)发生风险的相关性。方法 选取2017年3月至2018年3月因胸部不适在西安市第三医院心血管内科治疗的SAP患者230例作为研究对象，随访1年，根据随访期间是否发生AMI将患者分为未发生AMI组(n=122)和发生AMI组(n=108)。收集两组患者的临床资料，利用酶联免疫吸附法(ELISA)检测其血清Angpt2、Angpt1水平，通过多因素Logistic回归分析影响SAP患者发生AMI的危险因素；并利用ROC曲线分析血清Angpt2、Angpt1水平及Angpt2/Angpt1比值对 SAP患者发生AMI的预测价值。结果 发生AMI组患者的左室射血分数(LVEF)为(43.78±12.90)%，明显低于未发生AMI组的(49.02±15.33)%，Gensini积分为(90.85±27.64)分，明显高于未发生AMI组的(54.21±17.33)分，差异均有统计学意义(P<0.05)；两组患者的病变血管支数及冠脉造影后治疗方式比较差异均有统计学意义(P<0.05)；发生AMI组患者血清Angpt2水平及Angpt2/Angpt1比值分别为(6.07±1.84) ng/mL、4.25±1.36，均明显高于未发生AMI组的(4.55±1.39) ng/mL、2.56±0.81，血清Angpt1水平为(1.43±0.45) ng/mL，明显低于未发生AMI组的(1.78±0.52) ng/mL，差异均有统计学意义(P<0.05)；SAP患者血清Angpt2/Angpt1比值与Gensini积分呈正相关(r=0.679，P<0.05)；多因素 Logistic回归分析结果显示，病变血管支数、Gensini积分、冠脉造影后治疗、Angpt2、Angpt1及Angpt2/Angpt1比值均是影响SAP患者发生AMI的独立危险因子(P<0.05)；血清Angpt2、Angpt1水平及Angpt2/Angpt1比值预测SAP患者发生AMI的曲线下面积(AUC)分别为 0.874、0.765、0.944，最佳截断值分别为5.36 ng/mL、1.59 ng/mL、3.42。结论 SAP患者血清Angpt2水平及Angpt2/Angpt1比值升高、血清Angpt1水平降低与AMI发生风险密切相关，Angpt2/Angpt1比值对SAP患者发生AMI具有较高预测价值。
      【关键词】 稳定型心绞痛；急性心肌梗死；动脉粥样硬化；血管生成素-2；血管生成素-1；血管生成素-2/血管生成素-1比值；Gensini积分
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2019）22—2865—04

Correlation between serum Angpt2/Angpt1 ratio and risk of acute myocardial infarction in patients with stableangina pectoris.
QIN Jian-ning, DING Hui. Department of Cardiovascular Medicine, Affiliated Hospital of NorthwestUniversity/Third Hospital of Xi'an, Xi'an 710016, Shaanxi, CHINA
【Abstract】 Objective To investigate the correlation between the ratio of serum angiopoietin-2 (Angpt2)/angio-poietin-1 (Angpt1) and the risk of acute myocardial infarction (AMI) in patients with stable angina pectoris (SAP).Methods A total of 230 SAP patients with chest discomfort who were treated in Department of Cardiovascular Medi-cine, Third Hospital of Xi'an from March 2017 to March 2018 were selected as the study subjects. The patients were fol-lowed up for one year. According to whether AMI occurred during the follow-up period, the patients were divided intonon-AMI group (n=122) and AMI group (n=108). Clinical data of two groups were collected, and serum Angpt2 andAngpt1 levels were detected by ELISA. The risk factors of AMI in SAP patients were analyzed by multivariate logisticregression, and the ROC curve was used to analyze the predictive values of serum Angpt2 and Angpt1 levels and ratio ofAngpt2/Angpt1 for the occurrence of AMI in SAP patients. Results The left ventricular ejection fraction (LVEF) of thepatients with AMI was (43.78±12.90)%, significantly lower than (49.02±15.33)% of the patients without AMI. The Gen-sini score of the patients with AMI was 90.85±27.64, significantly higher than 54.21±17.33 of the patients without AMI(P<0.05). There were significant differences in the number of lesion vessels and the treatment after coronary angiogra-phy between the two groups (P<0.05). The levels of serum Angpt2 and the ratio of Angpt2/Angpt1 in patients with AMIwere (6.07±1.84) ng/mL and 4.25±1.36, significantly higher than (4.55±1.39) ng/mL and 2.56±0.81 in patients withoutAMI (P<0.05), and the level of serum Angpt1 was (1.43±0.45) ng/mL, significantly lower than (1.78±0.52) ng/mL in pa-tients without AMI (P<0.05). The ratio of serum Angpt2/Angpt1 was positively correlated with Gensini score in SAP pa-tients (r=0.679, P<0.05). Multivariate logistic regression analysis showed that, the number of vessel branches, Gensiniscore, post-coronary angiography treatment, Angpt2, Angpt1 and Angpt2/Angpt1 ratio were independent risk factors forAMI in SAP patients (P<0.05). The areas under the curve (AUC) of serum Angpt2, Angpt1 levels, and Angpt2/Angpt1