| Background and Objectives:Coronary artery calcification（CAC）is a pathological phenomenon in which calcium salts are abnormally deposited on the walls of coronary arteries.It is closely related to coronary heart disease（CHD）.Coronary artery calcification score（CACS）is often used clinically to predict the degree of CAC.CACS is one of the indicators reflecting the degree of coronary artery disease[1].A large number of research results show that parathyroid hormone（PTH）plays an important role in the process of coronary artery calcification.PTH is related to coronary artery calcification,and it is also related to coronary artery calcification score.In addition,most scholars believe that the carotid intima-media thickness（IMT）is not only a manifestation of atherosclerosis,but also related to coronary calcification scores.Since PTH and IMT are related to coronary artery calcification,whether PTH and IMT have a predictive effect on coronary artery calcification,and at the same time,how the combination of the two predicts coronary artery calcification,there are few relevant studies at home and abroad.Therefore,this study aims to study the predictive effect of the two alone and in combination on the degree of coronary artery calcification,and explore whether it can play a role in the prevention and treatment of coronary heart disease.Methods:The patients who were admitted to the Department of Cardiology of our hospital from December 2018 to March 2020 for suspected coronary heart disease were selected as the research subjects.The subjects improved the carotid artery color Doppler ultrasound and collected IMT measurements and perfected coronary artery computed tomography.After scanning（computed tomography angiography,CTA）and calculating CACS,record the general information and routine serological indicators of each patient,and then collect blood samples to detect plasma PTH levels.A total of299 cases were included,and 135 patients with incomplete hospitalization information were excluded,and a total of 164 patients entered the study.According to whether CACS is 0,the patients were divided into calcification group（101 cases）and non-calcification group（63 cases）.The chi-square test was used to perform statistical analysis on the count data such as gender,and the two independent sample t test was used to determine the serological indicators and IMT.Perform statistical analysis to compare whether the data is statistically different.Then according to CACS,the calcification components were divided into a small amount of calcification group（14cases）,a mild calcification group（34 cases）,a moderate calcification group（33 cases）,and a severe calcification group（20 cases）.One-way analysis of variance was used between the four groups Whether there is a difference between the plasma PTH and IMT groups.Then logistic regression analysis was used to screen out independent risk factors for CAC.Draw ROC（receiver operating characteristic,ROC）curve with PTH and IMT levels as test variables and coronary artery calcification as state variables,select PTH,IMT and PTH+IMT cut-off values according to the best Youden index,and calculate each cut-off separately The sensitivity,specificity,etc.corresponding to the value,evaluate the predictive power,compare whether the difference in the area under the ROC curve of the three is statistically significant,and then conduct a pairwise comparison to analyze the predictive value of CAC.Results:1.The analysis showed that the general data（smoking,drinking history,etc.）and serological indicators（ALP,calcium,phosphorus,blood lipids,etc.）between the calcification group and the non-calcification group were statistically indistinguishable（P<0.05）,while the two groups There were statistical differences in age,PTH,IMT,and blood glucose（P<0.05）.2.According to the calcification score,the calcification groups were divided into four groups.The study found that the PTH level of the four groups was significantly different.The PTH level of the severe calcification group was higher than the other three groups,and the PTH level of the moderate calcification group was higher than that of the mild and small calcification group.,The difference was statistically significant（P<0.05）.However,there was no statistically significant difference in TMT levels among the four groups（P>0.05）.3.The binary logistic regression analysis found that the factors related to coronary artery calcification were IMT,PTH,TG and HDL-C.PTH and IMT were independent risk factors for CAC.4.Draw ROC curve with PTH and IMT levels as test variables and coronary artery calcification as state variables.The area under curve（AUC）of PTH,IMT,PTH+IMT are 0.954,0.711 and 0.970,respectively.The 95%CI are 0.926～0.981,0.627～0.796 and 0.948～0.92,respectively,indicating that IMT has a certain predictive power for CAC diagnosis,and PTH and PTH+IMT have better predictive power.According to the best Youden index,calculate the cut-off value of IMT,IMT,PTH+IMT and the corresponding sensitivity,specificity,positive predictive value,and negative predictive value.When PTH is greater than 77pg/ml,the probability of CAC Larger,when IMT is greater than 0.98mm,CAC is more likely.It can be seen that PTH+IMT is the best predictor,followed by PTH,and finally IMT.After the analysis of the area under the ROC curve of the three,it is suggested that PTH,IMT,PTH+IMT all have a predictive effect on CAC,and the difference is statistically significant（P<0.001）.Through the comparison and analysis of the predictive value of the three,it is suggested that the predictive effect of PTH is significantly higher than that of IMT,and there is a significant difference in statistical test（P<0.0001）;the predictive effect of PTH combined with IMT is higher than that of PTH,and the difference is statistically significant（P=0.0429）;the predictive effect of PTH combined with IMT is higher than that of IMT,and there is a significant difference in statistical test（P<0.0001）;the results show that the predictive value of PTH combined with IMT is better than single index prediction.Conclusion:1.Compared with the non-calcification group,the levels of PTH and IMT are higher in the calcification group.2.The heavier the calcification,the higher the PTH level.3.Both PTH and IMT are related to CAC and are independent risk factors for CAC.4.PTH,IMT,PTH+IMT all have predictive effects on CAC.When PTH is greater than 77pg/ml,CAC is more likely,and when IMT is greater than 0.98mm,CAC is more likely.The predictive effect of PTH is significantly higher than that of IMT;the predictive effect of PTH combined with IMT is higher than that of PTH alone,and the predictive effect of PTH combined with IMT is significantly higher than that of IMT alone.All in all,the predictive value of PTH combined with IMT is better than that of a single indicator. |
