Correlation Between Hcy,Cys-C,TBIL And Severity Of Coronary Artery Disease In Patients With Acute Coronary Syndrome

ObjectiveThe purpose of this study was to explore the correlation between the expression levels of homocysteine（Hcy）,cystatin C（Cys-C）and total bilirubin（TBIL）in peripheral blood and the complexity of coronary artery disease and the predictive value of ACS in patients with acute coronary syndrome（ACS）,so as to provide clinical reference for the prevention,early diagnosis and monitoring of coronary artery disease.MethodsThe patients with coronary artery stenosis≥50%diagnosed by ACS and coronary angiography（CAG）in the Department of Cardiology of the second affiliated Hospital of Shenyang Medical College from January 2018 to December 2019 were collected as the case group.At the same time,non-ACS patients with coronary artery stenosis<50%indicated by CAG in the same period were selected as the control group（60 cases）.All the basic clinical data and laboratory indexes of fasting blood sampling for the first time after admission were collected,such as sex,age,previous medical history（hypertension,diabetes and other basic diseases）,family history,smoking,blood routine（RBC、WBC、HGB、PLT）,liver function（TBIL,DBIL,IBIL）,renal function（Scr,UA,BUN）,blood lipids（TC,TG,LDL-C,HDL-C）,Hcy,Cys-C and so on.According to the diagnostic criteria in the guidelines for Emergency Rapid diagnosis and treatment of Acute Coronary Syndrome（2019）^[1],patients with ACS were divided into three subgroups:unstable angina pectoris（UAP）group（68 cases）,acute non-ST segment elevation myocardial infarction（NSTEMI）group（40 cases）and acute ST segment elevation myocardial infarction（STEMI）group（42 cases）.According to the total number of coronary artery lesions displayed by CAG,the patients with ACS were divided into three groups:single-vessel disease group（47 cases）,double-vessel disease group（50 cases）and multi-vessel disease group（53 cases）.According to Gensini score,patients with ACS were divided into three subgroups:low-risk group（<20,49 cases）,medium-risk group（20≤score≤40,47 cases）,and high-risk group（54 cases,score>40）.The relative expression levels of serum Hcy,Cys-C and TBIL in patients with ACS were compared between the three groups and between the control group.The correlation between serum Hcy,Cys-C,TBIL levels and the number of coronary artery lesions was analyzed.Binary Logistic regression analysis was used to analyze the risk factors affecting ACS.ROC curve analysis of serum Hcy,Cys-C,TBIL respectively and combined detection of the predictive value of ACS.Results1.There was no significant difference in sex,age,smoking,hypertension,diabetes,RBC,HGB,PLT,Scr,UA,BUN and TG among the four groups（P>0.05）.There were significant differences in the levels of WBC,TC,LDL-C and HDL-C（P<0.05）.2.The levels of Hcy and Cys-C in STEMI group>NSTEMI group>UAP group>control group（Hcy:H=104.589,Cys-C:H=78.093,P<0.001）,the level of TBIL in STEMI group0.05）.The level of TBIL in multi-vessel disease groupmiddle risk group>low risk group,and the level of TBIL in high risk group0.05）.5.Spearman correlation analysis showed that there was a positive correlation between Hcy,Cys-C and the number of coronary artery lesions（r=0.334,r=0.445,P<0.001）,and a negative correlation between TBIL and he number of coronary artery lesions（r=-0.473,P<0.001）.6..Binary Logistic regression analysis showed that Hcy and Cys-C were risk factors for ACS（Hcy:OR=1.415,Cys-C:OR=69.358,P<0.05）,while TBIL and HDL-C were protective factors for ACS（TBIL:OR=0.796,HDL-C:OR=0.085,P<0.05）.7.According to the analysis of ROC curve,the area under Hcy curve（Area under curve,AUC）is 0.816（95%CI:0.755-0.877,P<0.05）,the best cut-off value is 11.700,the sensitivity is 74.7%,and the specificity is 76.7%.The AUC of Cys-C is 0.788（95%CI:0.728-0.848,P<0.05）,the best truncation value is 0.7350,the sensitivity is 53.3%,and the specificity is 96.7%.The AUC of TBIL is 0.813（95%CI:0.755-0.871,P<0.05）,the best truncation value is 13.450,the sensitivity is 60.7%,and the specificity is86.7%.The AUC of the three combined detection curves was 0.892（95%CI:0.849-0.936,P<0.05）,the sensitivity was 84.0%,and the specificity was 80.0%.ConclusionsHcy,Cys-C and TBIL are closely related to the occurrence of ACS,and with the aggravation of coronary artery disease,the expression level of Hcy and Cys-C is up-regulated and the expression level of TBIL is decreased,suggesting that they have a certain guiding significance for the evaluation of the severity of coronary artery disease and risk stratification in patients with ACS.At the same time,the separate and combined detection of these three indexes have a certain predictive value for the occurrence of ACS.