| Objective:1.To study the correlation between TNT,hs-CRP,NT-pro BNP,D-dimer,fibrinogen,average platelet content and grace score in peripheral blood of patients with unstable angina pectoris,and to judge the value of each marker in.risk stratification of unstable angina pectoris(UA).2.To study the value of combined detection of each marker and multiple markers,marker combined grace score in judging the prognosis of unstable angina pectoris.3.The correlations between vascular endothelial function and Grace score and markes were analyzed to evaluate its value in early risk stratification of UA patients.Methods:109 UA patients were admitted to PLA general hospital from June 2016 to January 2017.The basic values of laboratory indexes were measured within 24 hours after admission,and grace scores were calculated for risk stratification.The patients were divided into low-risk group(n =56)and middle-high-risk group(n=53).The statistically different indexes or clinical factors in the two groups were taken as independent variables,and multiple linear regression analysis was performed to find out the independent related factors of grace risk stratification.Four cases were missed for one year.According to the occurrence of end-point events,they were divided into event group(n = 35)and non-event group(n = 70).The clinical data and laboratory indicators of the two groups were compared,and different indicators were found out.ROC curve was made to obtain the cutoff value of each indicator,and the judgment effect of each indicator on prognosis was analyzed.ROC curve of multiple indicators combined detection was made through logistic regression analysis,and the judgment effect of each indicator combined detection and grace combined laboratory indicator detection on prognosis of patients with unstable angina pectoris was analyzed.New score was defined according to the level of meaningful markers,the number of markers that exceeded the cutoff value.The accuracy of new score in predicting prognosis was analyzed.A total of 50 patients with UA admitted to the Department of Hyperbaric Oxygen Therapy of the General Hospital of PLA from June 2017 to February 2018 were collected.The content of each marker was measured at admission and the endothelial function was measured by EndoPAT2000.According to whether the size of the admission RHI was greater than the median,patients were divided into high value group(RHI≥ 1.475)and low value group(RHI<1.475).The differences of various markers and Grace score between the two groups were analyzed.Results:1.Spearman correlation analysis showed that grace score was not correlated with fibrinogen and mean platelet volume(p>0.05),and grace score was positively correlated with hs-CRP,NT-pro BNP,D-dimer and TNT,the correlation coefficients were 0.624,0.472,0.405 and 0.437(p<0.001).2.The clinical data and laboratory indexes of patients in low risk group and middle-high risk group were compared.The final result:grace score = 21.872 +1.051*age ＋34.991*hs-CRP + 145.614 a*TNT + 6.876*D-dimer,and the standardized coefficients of age,hs-CRP,TNT and D-dimer were 0.565 0.288 0.1670.122respectively.3.The age,hs-CRP,NT-pro BNP and grace score of the event group were different from those of the non-event group(p<0.05).The AUC of hs-CRP,NT-pro BNP,grace score were made according to multiple linear test excluding age variables:0.798,0.812,0.813,and the cutoff value(sensitivity,specificity)was as follows hs-CRP 0.293(0.82,0.657)NT-proBNP79.75(0.886,0.643),Grace score103.5(0.914,0.629).When the cutoff value of Grace score was 109,the sensitivity was 74.3%,the specificity was 67.1%,the Yoden index was 0.414,the positive predictive value was 53.1%,and the negative predictive value was 83.9%.Compared with the prediction effect of NT-proBNP,the kappa value was 0.414,there is consistency in the prognosis of unstable angina.4.The area under ROC curve(sensitivity,specificity)of grace score combined with hs-CRP and NT-pro BNP,hs-CRP,NT-pro BNP to judge prognosis were 0.864(0.8,0.829),0.84(0.8,0.771),0.849(0.771,0.829),respectively.The area(sensitivity,specificity)under ROC curve of combined assessment of hs-CRP and NT-pro BNP was 0.853(0.743,0.843).5.The results of Logistic regression of new score and grace score were as follows:The OR of the new score of 2 points is 10.441(1.887,57.762)relative to 0 points,and the OR of grace score was 1.049.The AUC of new score,combined assessment of new score and grace score was 0.806 and 0.858,sensitivity was 0.771 and 0.8.6.when hs-CRP ≥ 0.293 and NT-proBNP ≥ 79.75 were positive,the sensitivity,specificity,Youden’ s index,positive predictive value,and negative predictive value were 0.829,0.8,0.629,0.674,0.903.7.In the low RHI group,the Grace score and hs-CRP,NT-proBNP,D-dimer and fibrinogen were significantly higher than the high RHI group.Conclusion:1.There was no correlation between grace score and fibrinogen or mean platelet volume(p>0.05).Age and hs-CRP and TNT and D-dimer were independent risk factors of grace score.Compared with other indicators,the correlation between hs-CRP and grace score is the strongest.It may has certain value in risk stratification of unstable angina pectoris.2.The effect of combined assessmentof hs-CRP and NT-pro BNP about prognosis of cardiovascular events in patients with unstable angina pectoris was the greatest.the combined detection of grace score and biomarkers could improve the accuracy of prognosis judgment.3.Hs-CRP>0.293 while NT-proBNP>79.75 was a high risk factor for cardiovascular events in UA patients at 1 year.4.The lower the RHI score,the higher the Grace score,the higher the risk stratification,and the vascular endothelial function has a certain value in predicting the prognosis of UA. |
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