| Objective: This study was designed to study peripheral blood homocysteine,Cystatin C,red blood cell distribution width relationship with coronary heart disease and other factors,severity of coronary artery disease,to further explore its predictive value for coronary heart disease as well as the cornary artery lesion severity.A possible clinical basis would be provided for the early detection,early treatment and blocking of the pathogenesis.Methods: A total of 1142 patients who underwent coronary angiography in CCU and the first department of coronary heart disease of our hospital from April 25,2018 to November 26,2018 were enrolled.According to the exclusion criteria,249 patients were enrolled,including 169 males and 80 females with an average age of 62.5 ± 11.1years old.The admission clinical data of the selected subjects were collected: age,gender,current medical history,past medical history,such as hypertension,diabetes and other medical history,smoking history,medication history.Record the results of fasting blood in the early morning after admission: RBC,HGB,HCT,RDW-CV,RDW-SD,ALT,AST,Cr,UA,BUN,Cys C,TC,TG,HDL-C,LDL-C,Apo A1,Apo B,Hcy,Met,Cys,etc.Grouped according to the number of lesions: at least 1 lumen diameter stenosis? 50%,is the case group,otherwise it is the control group,wherein the case group is divided into three subgroups according to the total number of cumulative counts of the affected area: single-vessel disease group,double-vessel disease group,multi-vessel disease group(3 or more lesions),of which left main lesion was recorded as 2 lesions.Grouped according to Syntax score: patients with coronary artery stenosis <50% or no coronary lesions were classified as control group,and coronary angiography confirmed that at least one patient with coronary stenosis ?50% was classified as coronary heart disease group.According to the Syntax score,patients with coronary heart disease were divided into:(1)low-risk group(0<score?22 points);(2)middle-risk group(22points<score<32 points);(3)high-risk group(score?32points).Results: The RDW,Cys C and Hcy levels in the case group were higher than those in the control group,and the difference was statistically significant(P<0.05).The RDWCV(Coefficient of variation)and RDW-SD(Standard Deviation)in the multi-vessel disease group were higher than those in the control group,and the RDW-SD in the double-vessel disease group was higher than that in the control group(P<0.05).The levels of Cys C in the multi-vessel disease group and the double-vessel disease group were higher than those in the control group,and the difference was statistically significant(P<0.05).The levels of Hcy in the multi-vessel disease group,double-vessel disease group and single-vessel disease group were significantly higher than those in the control group(P<0.05).The RDW-CV in the high-risk group was higher than that in the control group.The RDW-SD in the middle-risk group and the low-risk group was higher than that in the control group(P<0.05).The level of Cys C in the high-risk group was higher than that in the control group,and the difference was statistically significant(P<0.05).The levels of Hcy in the low-risk group,the middle-risk group and the highrisk group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).The diagnostic value of Hcy,RDW-CV,RDWSD and Cys C was analyzed by ROC curve.It was found that Hcy predicted coronary artery lesions with AUC=0.735,optimal cut-off value of 11.29umol/L,sensitivity of63%,specificity of 75%;RDW-CV predicts coronary artery lesions with AUC=0.625,optimal cut-off value of 12.65%,sensitivity of 66%,specificity of 55%,and RDW-SD predicts AUC=0.62 for coronary lesions,the point value was 42.05 Fl,the sensitivity was 62%,and the specificity was 60%.Cys C predicted AUC=0.643 for coronary lesions,the optimal cut-off value was 1.07 mg/L,the sensitivity was 41%,and the specificity was 88%.There was an independent and significant correlation between age,smoking,Hcy,AST,Apo A1 and coronary heart disease.Age,smoking,Hcy and AST were independent risk factors for coronary heart disease,and Apo A1 was an independent protective factor(P<0.05).Age,smoking,Hcy,AST,and Apo A1 were used to establish a multivariate logistic regression model to predict coronary lesions with an AUC of 0.75,a sensitivity of 71%,and a specificity of 90%.Conclusion: 1.The levels of RDW,Cys C and Hcy in patients with coronary heart disease were significantly higher than those in the control group,Hcy,RDW-CV,RDW-SD,Cys C respectively have diagnostic value for coronary heart disease,and the diagnostic value is ranked as Hcy>Cys C>RDW-CV>RDW-SD.2.The levels of RDW,Cys C and Hcy were significantly increased in patients with coronary artery disease and high-risk group with syntax score,which may have certain guiding significance for the diagnosis of coronary heart disease and the assessment of severity of disease.3.Combined multi-factor logistic regression prediction model with age,smoking,Hcy,AST and Apo A1 has certain value for the diagnosis of coronary heart disease. |
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