基于Gensini评分探究血清TNC水平、NHR比值与冠状动脉病变程度的相关性

Exploring the Correlation among Serum TNC Levels, NHR Ratio and Severity of Coronary Artery Lesions Based on Gensini Score

摘要: 目的：探究冠心病人群中血清肌腱蛋白C (TNC)、中性粒细胞计数/高密度脂蛋白胆固醇(NHR)与冠状动脉病变严重程度的相关性及联合预测价值。方法：选取2023年12月至2024年6月于承德市中心医院住院行冠状动脉造影(CAG)检查确诊冠心病的患者119例为研究对象(冠心病组)，以同期行冠状动脉造影检查阴性的患者69例为非冠心病组。比较两组患者的基线资料、血清TNC水平、NHR比值的差异性。根据冠脉病变程度将冠心病组又分为轻度狭窄组(67例)、中度狭窄组(29例)、重度狭窄组(23例)，比较三组间基线资料、血清TNC水平、NHR比值的差异性。分析血清TNC水平、NHR比值与其冠状动脉病变严重程度的相关性及其预测价值。结果：冠心病组患者血清TNC水平、NHR比值明显高于非冠心病组(P < 0.05)。不同狭窄程度的亚组之间比较，重度狭窄组患者血清TNC水平、NHR比值显著超过了轻、中度狭窄组(P < 0.05)，中度狭窄组患者血清TNC水平、NHR比值明显高于轻度狭窄组(P < 0.05)。Spearman相关性分析表明，冠心病患者血清TNC水平、NHR比值与冠状动脉狭窄程度之间存在着显著正相关关系(r = 0.589, r = 0.493, P < 0.01)。多因素Logistic回归分析显示血清TNC (OR: 1.330, 95% CI: 1.168~1.514, P < 0.001)、NHR (OR: 2.097, 95% CI: 1.420~3.095, P < 0.001)是冠状动脉中重度狭窄的独立危险因素。ROC曲线显示血清TNC水平、NHR比值预测冠状动脉中重度狭窄的AUC分别为0.792、0.763，二者联合预测冠状动脉中重度狭窄的AUC为0.852。联合预测的AUC明显大于TNC、NHR各自单独预测的AUC (Z = 2.126, Z = 2.479, P < 0.05)。结论：血清TNC水平、NHR比值与冠心病患者的冠状动脉狭窄程度呈正相关，两者对预测冠心病及冠状动脉中重度狭窄有一定的价值，联合预测优于单一指标预测。

Abstract: Objective: In a population with coronary heart disease, to examine the relationship and combined predictive value of serum Tenascin-C (TNC), serum neutrophil to high-density lipoprotein cholesterol ratio (NHR), and the severity of coronary artery lesions. Methods: 119 individuals having coronary angiography (CAG) diagnoses of coronary heart disease in Chengde Central Hospital from December 2023 to June 2024 were chosen as research participants (coronary heart disease group). As a control group, 69 individuals with negative coronary artery disease were chosen. According to the severity of coronary artery lesions, the coronary heart disease group was split up into a mild stenosis group (67 cases), a moderate stenosis group (29 cases), and a severe stenosis group (23 cases). The study aimed to compare the baseline data, serum TNC levels, and NHR ratios difference among the three groups. To analyze the correlation among the severity of coronary artery lesions and the serum TNC levels and NHR ratios of the patients. Additionally, to determine the predictive value of these measures. Results: Serum TNC levels and the NHR ratio were significantly higher in the coronary heart disease (CHD) group compared to the non-CHD group (P < 0.05). Furthermore, when comparing subgroups based on stenosis severity, serum TNC levels and the NHR ratio in the severe stenosis group significantly exceeded those in the mild and moderate stenosis groups (P < 0.05). Serum TNC levels and the NHR ratio were also significantly higher in the moderate stenosis group than in the mild stenosis group (P < 0.05). Spearman correlation analysis revealed a significantly positive correlation between serum TNC levels, the NHR ratio, and the severity of coronary artery stenosis in CHD patients (r = 0.589, r = 0.493, respectively; P < 0.01). Multivariate logistic regression analysis identified serum TNC (OR: 1.330, 95% CI: 1.168~1.514, P < 0.001) and NHR (OR: 2.097, 95% CI: 1.420~3.095, P < 0.001) as independent risk factors for moderate-to-severe coronary artery stenosis. ROC curve analysis showed that the AUCs for serum TNC levels and the NHR ratio in predicting moderate-to-severe coronary stenosis were 0.792 and 0.763, respectively. The combined predictive AUC for both markers was 0.852. This combined AUC was significantly greater than the AUCs for TNC or NHR alone (Z = 2.126, Z = 2.479, respectively; P < 0.05). Conclusion: Degree of coronary stenosis has a positive correlation between serum TNC and NHR levels, and serum TNC and NHR levels have a certain predictive value for the degree of moderate-to-severe coronary artery stenosis, and the combined prediction is better than a single index.