目的 探讨血清半胱氨酸蛋白酶抑制剂C(Cys-C)、妊娠相关血浆蛋白A(PAPP-A)、成纤维细胞生长因子21(FGF-21)在预测原发性高血压(EH)患者颈动脉粥样硬化(CAS)中的价值.方法 选取2015年1月至2017年12月于新疆维吾尔自治区人民医院全科医疗科就诊的EH患者200例,其中合并CAS患者80例(CAS组),单纯EH患者120例(EH组),另选择本院同期体检健康人员100名为健康对照组(HC组),比较3组研究对象血糖、尿素氮、血肌酐、血尿酸、总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、Cys-C、PAPP-A、FGF-21水平及颈动脉内膜中层厚度(cIMT)的差异,应用多因素线性回归模型分析血清标志物与cIMT的相关性,应用受试者工作特征曲线评价血清Cys-C、PAPP-A及FGF-21水平在预测EH合并CAS中的效能.结果 CAS组的总胆固醇、三酰甘油、LDL-C、cIMT、Cys-C、PAPP-A和FGF-21水平均明显高于EH组和HC组(均P＜0.05),EH组和CAS组的HDL-C均显著低于HC组(均P＜0.05).多因素线性回归分析显示,cIMT与血清总胆固醇、LDL-C、Cys-C、PAPP-A及FGF-21水平呈正相关,与HDL-C呈负相关(均P＜0.05).受试者工作特征曲线显示,Cys-C和FGF-21预测CAS的曲线下面积(AUC)较高(AUC =0.761、0.765),其次为PAPP-A和LDL-C(AUC=0.696、0.636),HDL-C和总胆固醇较低(AUC=0.624、0.609);应用Cys-C、PAPP-A和FGF-21联合诊断后诊断效能得到明显提高(AUC=0.857).3种指标联合诊断CAS的敏感度高于单独应用Cys-C、PAPP-A和FGF-21(88.75％比80.00％、75.00％、81.25％)(均P＜0.05),而诊断准确率无明显变化(均P＞0.05).结论 血清Cys-C、PAPP-A及FGF-21水平与EH患者CAS间存在明显的相关性,联合检测Cys-C、PAPP-A及FGF-21对预测EH患者的CAS具有较高的诊断效能.%Objective To investigate the values of serum cystatin-C (Cys-C),pregnancy-associated plasma protein-A (PAPP-A) and fibroblast growth factor-21 (FGF-21) in prediction of carotid atherosclerosis (CAS) in patients with essential hypertension(EH).Methods From January 2015 to December 2017,200 EH patients and 100 healthy people(HC group) were enrolled in People's Hospital of Xinjiang Uygur Autonomous Region;EH patients were divided into EH with CAS group(n =80) and simple EH group(n =120).Levels of blood glucose,urea nitrogen,creatinine,uric acid,total cholesterol,triacylglycerol,high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),Cys-C,PAPP-A,FGF-21 and carotid intimamedia thickness(cIMT) were tested.Relations between serum indicators and cIMT were analyzed by multivariate linear regression.Values of Cys-C,PAPP-A and FGF-21 in prediction of EH with CAS were analyzed by the receiver operating characteristic(ROC) curve.Results Serum levels of total cholesterol,triacylglycerol,LDL-C,cIMT,Cys-C,PAPP-A and FGF-21 in EH with CAS group were significantly higher than those in simple EH group and HC group(P ＜0.05).Serum level of HDL-C in simple EH group and EH with CAS group was significantly lower than that in HC group (P ＜ 0.05).Multivariate linear regression analysis showed that cIMT was positively related to total cholesterol,LDL-C,Cys-C,PAPP-A and FGF-21 and negatively related to HDL-C (P ＜ 0.05).Area under ROC curve(AUC) of Cys-C,FGF-21,PAPP-A,LDL-C,HDL-C and total cholesterol in predicting CAS was 0.761,0.765,0.696,0.636,0.624 and 0.609.Combined detection of Cys-C,PAPP-A and FGF-21 showed a high diagnostic efficacy (AUC =0.857).Diagnostic sensitivity of combined detection of Cys-C,PAPP-A and FGF-21 was significantly higher than that of the individual detection (88.75％ vs 80.00％,75.00％,81.25％) (P ＜ 0.05).Diagnostic accuracy showed no significant difference between combined detection and individual detection(P ＞ 0.05).Conclusions Serum levels of Cys-C,PAPP-A and FGF-21 are related with CAS in EH patients.Combined detection of Cys-C,PAPP-A and FGF-21 shows a good value in prediction of EH with CAS.
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