摘要目的 分析无症状中低风险人群冠状动脉CT血管成像(CCTA)特征与血清可溶性黏附分子水平相关性,评价可溶性 E-选择素( sE-selectin)对冠状动脉高风险斑块的预测价值.方法 收集解放军总医院2015年8月至2016年7月间行CCTA检查的无症状患者400例,经纳入排除标准筛选后抽取患者外周静脉血进行4种黏附分子[可溶性血管细胞黏附分子(sVCAM-1);可溶性细胞间黏附分子(sICAM-1);可溶性E选择素(sE-Selectin);可溶性P选择素(sP-Selectin)]检测.根据斑块成分分为高风险斑块组、钙化斑块组和无斑块组进行统计学分析,绘制ROC曲线评价相关指标对冠状动脉高风险斑块的预测价值.结果 高风险斑块组 sICAM-1 和 sE-Selectin 水平明显升高;sVCAM-1和sP-Selectin组间分布无差异(P＝0.772和0.234).二元Logistic回归分析结果显示:男性(OR＝2.131,P＝0.019)、年龄(OR＝1.053,P＝0.002)、高血脂病史(OR＝1.960,P＝0.022)、载脂蛋白B(apoB)(OR＝2.896,P＝0.004)及sE-Selectin(OR＝1.975,P＝0.008)是冠状动脉高风险斑块的独立预测因素(P＜0.05). ROC曲线下面积为0.722,sE-Selectin最佳截断点为73.14 ng/ml,敏感度55.3%,特异度78.3%,阳性预测值( PV+)71.8%,阴性预测值( PV-)64.4%.结论 在无症状中低风险人群中,sE-Selectin是冠状动脉高风险斑块的独立预测因素.监测外周血sE-Selectin水平可在无症状中低风险人群CTA检查前的筛查中起到一定作用.

abstractsObjective To examine the predictive value of serum soluble E-selectin ( sE-selectin) levels for high risk plaques as detected by coronary computed tomography angiography ( CCTA).Methods This was a cross-sectional study.CCTA was performed for each patient.Serum levels of sE-Selectin, sVCAM-1,sICAM-1 and sP-Selectin were measured by flow fluorescence immunomicrobead assay ( FFIA). ROC curve and multivariate analysis were used to determine the predictive value for the presence of high risk plaques.Results The high risk plaques group showed higher sICAM-1 and sE-selectin levels.The multivariate Logistic analysis showed that male (OR＝2.131, P＝0.019), old age (OR＝1.053, P＝0.002), hyperlipidemia (OR＝1.960, P＝0.022), high level of apoB (OR＝2.896, P＝0.004) and high level of sE-Selectin(OR＝1.975, P＝0.008) were independently associated with the presence of high risk plaques.The AUC of the multivariate model for high risk plaques was 0.722.The sensitivity, specificity, the positive predictive value and the negative predictive value were 55.3%, 78.3%, 71.8% and 64.4%respectively.Conclusions High sE-selectin levels were associated with the presence of high risk plaques in asymptomatic populations at low to intermediate Framingham risk .sE-selectin can play an important role in plaque screening, as detected by coronary CTA.