| Microalbuminuria (MAU) is not only the sensitive indexes of renal vascular and renal microvascular disease, but also is the early performance of systemic vascular lesions. In the coronary atherosclerotic disease, vascular disease is one of the main reasons for death of patients with vascular lesions, including macrovascular and microvascular disease. Albumin filtrate will increase and form microalbuminuria in renal microvascular disease.And.microalbuminuria itself is the important clinical manifestations of aendothelial dysfunction and vascular lesions. In recent year, with the prevalence of coronary artery disease and its young tendency, coronary artery disease becomes a serious threat to health problems for the population in China. At present, coronary angiography is the "gold standard" in the diagnosis of coronary artery disease, it is not suitable for screening of coronary artery disease and early diagnosis. Therefore, we need to find simple, rapid, sensitive, noninvasive method for screening coronary artery disease high-risk people, to prevent cardiovascular events early, in order to reduce the incidence.Objective:To observe the correlation between urinary albumin/creatinine ratio (ACR) and coronary artery disease and coronary lesion severity, and to investigate the optimal critical value in predicting cardiovascular events risk. Then, combined with other biochemical indexes to improve its predictive value and provide an effective screening index for coronary artery disease.Methods:The study includes three parts.1. To detect ACR levels of220patients with coronary artery disease confirmed by coronary angiography and50healthy subjects (control group). To observe the correlation between ACR and coronary artery disease and coronary lesion severity. Then, to compare the correlation of different ACR levels with coronary angiography Gensini in coronary artery disease patients.2. To design ROC curve of patients with coronary ateryt disease and the control group and calculate the area under the curve, and to predict the optimal critical point of coronary artery disease by the maximum of Youden exponent corresponding to ACR. To compare ACR critical value commonly used in clinical and the critical value, the sensitivity of specificity, Youden index in this study Then, to compare ACR levels between patients with coronary artery disease only and patients with coronary artery disease and hypertension and (or) type2diabetes mellitus. The best critical value of ACR in prediction of coronary artery disease were calculated respectively in patients with cardiovascular disease.3. To assess the value of ACR and other markers of renal function prediction ofcoronary artery disease, and to analyze the relationship between CysC and the severity of coronary artery lesion, in order to investigate the value of ACR combined with CysC detection for coronary artery disease risk prediction.Results:1. The ACR level of patients with coronary heart disease was significantly higher than that control group. ACR levels was significantly elevated with the continuous progress, increase of coronary arterial lesion vessels and increase of Gensini integral.2. According to the ROC curve, the maximum Youden index numerical at thecritical point, the optimal critical value ACR to predict risk of coronary artery disease is10.24mg/g (Youden index=0.75). And comparison of the guidelines for the treatment of type2diabetes China(2007Edition) ACR critical value, the sensitivity of ACR for predicting risk of coronary artery disease was increased from27.7%to79.5%, and Youden index was increased from0.28to0.75. The ACR levels of coronary artery disease complicated with hypertension and (or) in patients with type2diabetes mellitus was significantly higher than that in patients with coronary heart disease only. ACR levels increased as the number of diseased coronary artery and Gensini integral increased. The optimal critical value of simple CHD group, hypertension group, diabetic group, patients with hypertension and type2diabetic patients at the same time were7.71mg/g (Youden index=0.63),10.23mg/g (Youden index=0.81),10.38mg/g (Youden index=0.82),10.35mg/g (Youden index=0.77), respectively. Compared with control group, there was no statistical difference in age, gender, blood lipid indicators (TC, TG, HDL-C, LDL-C), BUN, Cr, UA.The serum CysC and urinary ACR levels were significantly higher than controls. Compared with other indexes of renal function.the predictive value of ACR in coronary heart disease was the best, its area under the ROC curve was0.947. Analysis of the ROC curve, the optimal critical value of CysC for predicting the risk of coronary artery disease was0.72mg/g, the sensitivity was72.7%. In addition to combined the two detection indexes, sensitivity was88.6%, Youden index was0.85. Conclusion:1. The ACR level of patients with coronary heart disease was significantly higher than control group, which had a good correlation the severity of coronary artery disease with a good correlation. ACR as a noninvasive method is simple,rapid,and has a good agreement whith coronary angiography results, which can be used as an important indicator of screening high-risk patients with coronary artery disease would contribute to the treatment and prognosis of early definite positive and effective, further reduce the morbidity and mortality of patients. Therefore, it should be taken the clinician’s attention.2. ACR as to predict the critical values for risk of coronary artery disease should not follow the reference range of ACR proposed by the guidelines for the treatment of type2diabetes mellitus (2007Edition), ACR must be reduced in order to improve the critical value in the prediction of coronary artery disease.3. The CysC level of patients with coronary heart disease was significantly higher than control group, which showed a good correlation between CysC levels and the severity of coronary artery disease. These results suggested that the lower critical point of CysC may improve the prediction value of coronary artery diseas. And, the predictive value of combined detection of ACR and CysC was better for coronary artery disease. |
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