血清VCAM-1、Gal-3、Hcy在冠心病患者病情评估中的价值

doi:10.3969/j.issn.1673-8640.2025.03.008

摘要/Abstract

摘要：

目的探讨血管细胞黏附分子-1（VCAM-1）、半乳糖凝聚素-3（Gal-3）和同型半胱氨酸（Hcy）水平在冠心病（CHD）患者中的变化及价值。方法选取2023年2月—2024年7月上海电力医院经冠状动脉造影确诊的CHD患者118例（CHD组）和健康体检者120名（正常对照组）。根据CHD疾病类型、冠状动脉造影结果和纽约心脏病学会（NYHA）分级标准将CHD患者分别分组。收集所有患者的临床资料，并检测VCAM-1、Gal-3、Hcy、血糖（Glu）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、总胆固醇（TC）水平。采用Spearman相关分析评估各项目之间的相关性。采用多因素Logistic 回归分析评估CHD发生的危险因素，采用受试者工作特征（ROC）曲线评价各项指标诊断CHD的效能。结果 CHD组吸烟史、体重指标（BMI）和血清VCAM-1、Gal-3、Hcy、Glu、LDL-C、TC、TG水平均高于正常对照组（P<0.05），血清HDL-C水平低于正常对照组（P<0.05）。SAP组、UAP组、AMI组血清VCAM-1、Gal-3、Hcy水平依次升高（P<0.001）。轻度狭窄组、中度狭窄组、重度狭窄组血清VCAM-1、Gal-3、Hcy水平依次升高（P<0.01）。NYHA Ⅰ+Ⅱ级组、NYHA Ⅲ级组和NYHA Ⅳ级组血清VCAM-1、Gal-3、Hcy水平依次升高（P<0.001）。血清VCAM-1、Gal-3、Hcy与冠状动脉狭窄程度、NYHA分级均呈正相关（P<0.001）。VCAM-1、Gal-3、Hcy、BMI、Glu、吸烟史、TC、TG、LDL-C升高和HDL-C降低均是CHD发生的危险因素（P<0.05）。血清VCAM-1、Gal-3、Hcy单项检测和联合检测诊断CHD的AUC分别为0.856、0.845、0.873、0.952。结论 CHD患者VCAM-1、Gal-3、Hcy水平与CHD的疾病类型和病情严重程度有关，或可作为CHD病情评估的生物标志物。

关键词: 血管细胞黏附分子-1, 半乳糖凝聚素-3, 同型半胱氨酸, 冠心病

Abstract:

Objective To investigate the changes and value of vascular cell adhesion molecule-1（VCAM-1），galectin-3（Gal-3）and homocysteine（Hcy）levels in patients with coronary heart disease（CHD）. Methods From February 2023 to July 2024，118 patients diagnosed with CHD by coronary angiography （CHD group）and 120 healthy subjects（healthy control group）were enrolled at Shanghai Electric Power Hospital. The CHD patients were classified based on CHD types，coronary angiography results and New York Heart Association（NYHA） classification criteria. The clinical data were collected，and the levels of VCAM-1，Gal-3，Hcy，glucose（Glu），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），triglyceride（TG）and total cholesterol（TC）were determined. Spearman correlation analysis was used to assess the relationship between variables. Multivariate Logistic regression analysis was used to evaluate the risk factors for CHD，and receiver operating characteristic（ROC）curve was used to evaluate the efficacy of each indicator in the diagnosis of CHD. Results The smoking history，body mass index（BMI）and serum levels of VCAM-1，Gal-3，Hcy，Glu，LDL-C，TC and TG in CHD group were higher than those in control group（P<0.05），while the serum level of HDL-C was lower（P<0.05）. The serum levels of VCAM-1，Gal-3 and Hcy in stable angina pectoris（SAP）group，unstable angina pectoris（UAP）group and acute myocardial infarction（AMI）group were increased in turn（P<0.001）. The serum levels of VCAM-1，Gal-3 and Hcy in mild stenosis group，moderate stenosis group and severe stenosis group were increased in turn（P<0.01）. The serum levels of VCAM-1，Gal-3 and Hcy in NYHA class Ⅰ+Ⅱ group，NYHA class Ⅲ group and NYHA class Ⅳ group were increased in turn（P<0.001）. Serum VCAM-1，Gal-3 and Hcy levels were positively correlated with the degree of coronary artery stenosis and NYHA classification （P<0.05）. Increased VCAM-1，Gal-3，Hcy，BMI，Glu，smoking history，TC，TG，LDL-C and decreased HDL-C were risk factors for CHD （P<0.05）. The areas under curves （AUC） of single and combined determinations of serum VCAM-1，Gal-3 and Hcy in the diagnosis of CHD were 0.856，0.845，0.873 and 0.952，respectively. Conclusions Serum levels of VCAM-1，Gal-3 and Hcy in patients with CHD are related to the types and severity of CHD，and may be used as biomarkers for CHD assessment.

Key words: Vascular cell adhesion molecule-1, Galectin-3, Homocysteine, Coronary heart disease

中图分类号:

R446.1

舒铭. 血清VCAM-1、Gal-3、Hcy在冠心病患者病情评估中的价值[J]. 检验医学, 2025, 40(3): 247-252.

SHU Ming. Roles of serum VCAM-1，Gal-3 and Hcy expression levels in evaluating patients with coronary heart disease[J]. Laboratory Medicine, 2025, 40(3): 247-252.

图/表 8

参考文献 20

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组别	例数	年龄/岁	性别		BMI/ （kg·m^-2）	吸烟史/ [例（%）]	Glu/ （mmol·L^-1）	HDL-C/（mmol·L^-1）
组别	例数	年龄/岁	男/例	女/例	BMI/ （kg·m^-2）	吸烟史/ [例（%）]	Glu/ （mmol·L^-1）	HDL-C/（mmol·L^-1）
CHD组	118	63.42±14.56	65	53	23.84±2.34	57（48.31）	6.48±1.64	1.36±0.29
正常对照组	120	62.81±13.69	69	51	20.82±2.22	40（33.33）	4.94±0.75	1.68±0.39
统计值		0.62	0.141		10.22	5.52	9.27	6.94
P值		0.54	0.707		<0.001	0.019	<0.001	<0.001
组别	LDL-C/（mmol·L^-1）		TC/（mmol·L^-1）		TG/（mmol·L^-1）	VCAM-1/（pg·mL^-1）	Gal-3/（ng·mL^-1）	Hcy/（µmol·L^-1）
CHD组	3.15±0.74		6.11±0.74		1.33±0.54	804.35（624.67~989.76）	4.15（2.26~6.16）	20.73±5.75
正常对照组	2.51±0.56		4.64±1.00		0.72±0.24	425.46（246.38~595.29）	1.23（0.68~2.29）	9.71±2.36
统计值	7.55		12.92		11.25	14.18	12.44	19.40
P值	<0.001		<0.001		<0.001	<0.001	<0.001	<0.001

组别	例数	年龄/岁	性别		BMI/ （kg·m^-2）	吸烟史/ [例（%）]	Glu/ （mmol·L^-1）	HDL-C/（mmol·L^-1）
组别	例数	年龄/岁	男/例	女/例	BMI/ （kg·m^-2）	吸烟史/ [例（%）]	Glu/ （mmol·L^-1）	HDL-C/（mmol·L^-1）
CHD组	118	63.42±14.56	65	53	23.84±2.34	57（48.31）	6.48±1.64	1.36±0.29
正常对照组	120	62.81±13.69	69	51	20.82±2.22	40（33.33）	4.94±0.75	1.68±0.39
统计值		0.62	0.141		10.22	5.52	9.27	6.94
P值		0.54	0.707		<0.001	0.019	<0.001	<0.001
组别	LDL-C/（mmol·L^-1）		TC/（mmol·L^-1）		TG/（mmol·L^-1）	VCAM-1/（pg·mL^-1）	Gal-3/（ng·mL^-1）	Hcy/（µmol·L^-1）
CHD组	3.15±0.74		6.11±0.74		1.33±0.54	804.35（624.67~989.76）	4.15（2.26~6.16）	20.73±5.75
正常对照组	2.51±0.56		4.64±1.00		0.72±0.24	425.46（246.38~595.29）	1.23（0.68~2.29）	9.71±2.36
统计值	7.55		12.92		11.25	14.18	12.44	19.40
P值	<0.001		<0.001		<0.001	<0.001	<0.001	<0.001

组别	例数	VCAM-1/（pg·mL^-1）	Gal-3/（ng·mL^-1）	Hcy/（µmol·L^-1）
SAP组	40	612.54（498.86~813.56）	2.64（1.56~3.64）	10.15±2.93
UAP组	38	815.76（675.53~937.89）*	3.89（3.12~4.69）*	17.94±3.42*
AMI组	40	934.75（823.23~1 098.78）*#	4.91（4.15~6.25）*#	21.97±3.67*#
统计值		34.352	12.537	13.674
P值		<0.001	<0.001	<0.001

组别	例数	VCAM-1/（pg·mL^-1）	Gal-3/（ng·mL^-1）	Hcy/（µmol·L^-1）
SAP组	40	612.54（498.86~813.56）	2.64（1.56~3.64）	10.15±2.93
UAP组	38	815.76（675.53~937.89）*	3.89（3.12~4.69）*	17.94±3.42*
AMI组	40	934.75（823.23~1 098.78）*#	4.91（4.15~6.25）*#	21.97±3.67*#
统计值		34.352	12.537	13.674
P值		<0.001	<0.001	<0.001

组别	例数	VCAM-1/（pg·mL^-1）	Gal-3/（ng·mL^-1）	Hcy/（µmol·L^-1）
轻度狭窄组	46	604.32（486.97~785.84）	2.47（1.51~3.55）	14.64±2.75
中度狭窄组	39	786.98（642.87~908.96）*	3.76（3.03~4.54）*	17.43±3.31*
重度狭窄组	33	927.00（811.54~1 045.87）*#	4.86（4.06~6.07）*#	20.99±3.64*#
统计值		32.321	11.564	9.263
P值		<0.001	<0.001	0.003