| Objective:In this study,the correlation between red blood cell distribution width(RDW)and soluble growth stimulation expression gene 2 protein(sST2)in the severity of lesions in patients with acute coronary syndrome(ACS)was analyzed to explore the diagnostic and clinical significance of RDW and sST2 in patients with ACS.Methods:In this study,319 hospitalized patients admitted to the cardiovascular Department of Bethune Hospital from January 2022 to June 2022 due to their first episode of chest pain were collected.All patients received coronary angiography(CAG).196 patients with ACS were diagnosed with CAG,Patients with ACS were further classified into STsegment elevation myocardial infarction(STEMI)group,Non-ST segment elevation myocardial infarction(NSTEMI)group,unstable angina pectoris(UA)group.At the same time,123 hospitalized patients with no obvious abnormality in CAG results were selected as the control group.General information such as patient name,gender,hospitalization number,history of hypertension,type 2 diabetes,smoking,and alcohol consumption were recorded.White blood cell count(WBC),red blood cell count(RBC),platelet count(PLT),neutrophil count(NE),lymphocyte count(LY),hemoglobin(Hb),RDW,mean red blood cell volume(MCV),mean red blood cell hemoglobin volume(MCH),mean red blood cell hemoglobin concentration(MCHC),sST2,myoglobin(Myo),hypersensitive troponin I(hs-c Tn I),creatine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),homocysteine(Hcy),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),triglyceride(TG),creatinine(Cr),urea nitrogen(BUN),uric acid(UA),cardiac ultrasound results(LVEF value),Gensini score and other clinical data were recorded.The differences of RDW,sST2 and other assay indexes between the ACS group and the control group were compared.The differences of RDW and sST2 among UA,NSTEMI and STEMI groups were further compared.The number of coronary artery lesions was recorded according to the CAG results,and ACS patients were divided into single-vessel disease group,double-vessel disease group,and multi-vessel disease group.The severity of coronary artery was calculated according to Gensini score,and the correlation between serum RDW and sST2 levels and the severity of coronary artery lesions in ACS patients was explored.The independent risk factors of ACS were analyzed by binary Logistic regression,and the diagnostic value of RDW and sST2 levels for ACS was evaluated by ROC curve.Results:1.General clinical data: According to case inclusion criteria and exclusion criteria,319 subjects were included in the study,including 196 patients in the ACS group and 123 patients in the control group.There was no significant difference in age,sex,smoking,alcohol consumption,type 2 diabetes,LY,MCH,MCHC,PLT,TG,HDL,ALT,AST,ALB,Cr,BUN,UA,or LVEF between the two groups(P> 0.05).There were significant differences in hypertension,WBC,NE,NLR,RBC,Hb,MCV,TC,LDL and Hcy(P < 0.05).2.Comparison of RDW and sST2 between ACS group and control group: RDW and sST2 in ACS group were higher than those in control group,with statistical significance(P < 0.05).3.Comparison of RDW and sST2 levels in different groups of patients in the ACS group: RDW and sST2 in UA group,NSTEMI group and STEMI group were statistically significant(P < 0.05),and RDW and sST2 in STEMI group were higher than those in NSTEMI group and UA group(P < 0.05).RDW and sST2 in NSTEMI group were higher than those in UA group(P < 0.05).4.Comparison of different diseased branch groups in ACS patients: Compared with the control group,RDW and sST2 in single-branch disease group,double-branch disease group and multi-branch disease group were significantly higher than those in the control group,and the difference was statistically significant(P < 0.05).RDW levels were statistically significant between single-vessel disease group and multi-vessel disease group,and between double-vessel disease group and multi-vessel disease group(P<0.05),there was no statistical significance in RDW level between singlevessel disease group and double-vessel disease group(P>0.05).sST2 levels were statistically significant in the multi-vessel disease group compared with the singlevessel disease group(P< 0.05),there was no statistical significance in serum sST2 level between single-branch disease group and double-branch disease group,and between double-branch disease group and multi-branch disease group(P>0.05).5.Spearman linear correlation analysis showed that RDW was positively correlated with Gensini score in ACS group(r=0.581,P<0.001).There was a positive correlation between sST2 and Gensini scores in the ACS group(r=0.452,P<0.001).6.Binary Logistic regression analysis of independent factors influencing the severity of ACS coronary artery disease: Binary Logistic regression analysis of risk factors affecting the severity of ACS patients.With WBC,NE,NLR,RBC,Hb,MCV,RDW,TC,LDL,Hcy and sST2 as independent variables,single Logistic analysis showed that WBC,NE,NLR,RBC,Hb,MCV,RDW,LDL,Hcy and sST2 were risk factors for ACS.All the indicators that had statistical significance in univariate Logistic regression analysis were included in the regression equation for multivariate Logistic analysis.The results showed that MCV,RDW and sST2 were risk factors for ACS,and the OR values were 1.126,2.645 and 1.071,respectively.7.Diagnostic value of RDW and sST2 in ACS: ROC curve showed that the area under RDW,sST2 and combined prediction variables were 0.898,0.889 and 0.929,respectively(P<0.05).RDW,sST2 and joint prediction probability were 12.65,15.25 and 0.35,respectively.The diagnostic efficiency was the highest,the sensitivity was91.8%,73% and 96.4%,and the specificity was 78%,88.6% and 72.4%,respectively.The 95% confidence intervals for RDW,sST2,and joint prediction probability were(0.860,0.935),(0.855,0.923),(0.902,0.956),respectively.Conclusion:1.RDW and sST2 are independent risk factors for ACS,and the levels of RDW and sST2 are continuously increased with the increase of the severity of coronary artery lesions.2.RDW and sST2 can be used as new clinical markers to predict the severity of coronary lesions in patients with ACS,and their combination has a higher sensitivity to predict ACS. |
