冠心病患者血管性血友病因子裂解酶水平与GRACE评分及Gensini积分的相关性分析

Correlation among von Willebrand factor-cleaving protease levels in peripheral blood，GRACE score and Gensini score in patients with coronary heart disease

摘要:

目的：检测冠心病患者外周血血管性血友病因子裂解酶（von Willebrand factor-cleaving protease，vWF-cp）的水平变化以及联合全球急性冠脉注册事件（Global Registry of Acute Coronary Events，GRACE）评分观察对冠心病危险分层的评估价值。方法：选取冠心病患者96例，其中稳定性心绞痛组（stable angina pectoris，SAP）47例，急性冠脉综合征组（acute coronary syn－drome，ACS）49例；同时选取同期无血管病变的非冠心病患者49例作为对照组，采用GRACE系统进行评分及分层，同时利用Gensini评分系统评定冠状动脉狭窄程度，用酶联免疫吸附法（enzyme-linked immuno sorbent assay，ELISA）测定外周血vWF-cp的浓度。结果：对照组的vWF-CP水平明显高于ACS组（P=0.000），亦明显高于SAP组（P=0.000），ACS组与SAP组相比，差异有统计学意义（P=0.023）；ACS组GRACE评分明显高于对照组（P=0.000），SAP组亦明显高于对照组（P=0.008），ACS组与SAP组相比，ACS组明显升高，差异有统计学意义（P=0.033）；不同Gensini积分的冠心病患者的vWF-cp水平比较，差异无统计学意义（P >0.05）。冠心病患者Gensini积分等级与vWF-cp水平无明显相关性（r=0.060，P＝0.６１６）（采用Spearman’s rho法）。GRACE评分等级与vWF-cp水平呈负相关（r=-0.672，P=0.000）（采用Spearman’s rho法）。结论：GRACE评分联合vWF-cp可以在临床上更准确、有效的预测冠心病患者的风险及预后。

Abstract:

Objective：To investigate the peripheral blood of von Willebrand factor-cleaving protease（vWF-cp） levels in patients with coronary heart disease（CHD） and its correlation with global registry of acute coronary events（GRACE） score then to assess the risk of CHD with the combination of them. Methods：Totally 145 patients who underwent coronary angiography were selected as research subjects. They were divided into three groups by coronary angiography：49 patients with non-coronary heart disease as control group；47 patients with stable angina（SAP） as SAP group；49 patients with acute coronary syndrome（ACS） as ACS group. All patients were scored by GRACE system and then layered. Meanwhile，degree of coronary artery stenosis was assessed by Gensini scoring system and vWF-cp level was measured by ELISA. Results：vWF-cp levels in control group were strikingly higher than those in ACS group（P=0.000） and also higher than those in SAP group（P=0.000）；vWF-cp levels in ACS group were obviously decreased compared with those in SAP group（P=0.023）. GRACE scores in ACS and SAP groups were increased compared with those in control group（P=0.000）（P=0.008）；GRACE score in ACS group was increased compared with that in SAP group（P=0.033）. There was no significant difference in vWF-cp level among CHD patients with different Gensini scores（r=0.060，P＝0.６１６），but GRACE score was negatively correlated with vWF-cp levels（r=-0.672，P=0.000）. Conclusion：Combination of GRACE score and vWF-cp levels could predict risk and progno－sis in patients with CHD accurately and efficiently.