Diagnostic value and method of soluble transferrin receptor for suspected coronary artery disease: a case-control study.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiovascular diagnosis and therapy Pub Date : 2024-06-30 Epub Date: 2024-06-14 DOI:10.21037/cdt-23-450
Zheng Wang, Banglong Xu, Yan Tan, Tingting Fan
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引用次数: 0

Abstract

Background: Many studies have pointed out that iron overload in the body is a risk factor for coronary atherosclerosis (AS), while there are also studies that show that iron deficiency is associated with coronary AS. There is still no consensus on how iron metabolism affects coronary artery disease (CAD). This study aimed to analyze the relationship between iron metabolism indexes and CAD, investigate the diagnostic value of soluble transferrin receptor (sTfR) in suspected CAD, and establish a diagnostic model.

Methods: This was a retrospective study. A total of 268 people with CAD-like symptoms who underwent coronary angiography in the Department of Cardiovascular Medicine, The Second Affiliated Hospital of Anhui Medical University from September 2022 to May 2023 without other chronic diseases or related medication history were included in the study and formed a continuous series including 188 CAD patients and 80 control subjects. Each iron metabolism index was divided into a grade variable according to tertile. The comparison of CAD morbidity between the tertiles and nonlinear correlation test was conducted to investigate the relationship between iron metabolism indexes and CAD risk. We used restricted cubic spline (RCS) to plot the relationship curve between sTfR and CAD risk and to determine the sTfR value corresponding to the minimal odds, according to which we divided the total sample into the "sTfR low level" subgroup and the "sTfR high level" subgroup. Logistic regression analyses were used to establish diagnostic models in both subgroups. The diagnostic efficiency of the indexes and models was compared by receiver operating characteristic (ROC) analysis.

Results: There is a "J" shape correlation between sTfR and CAD risk. Age/sTfR ratio [area under the curve (AUC) =0.690, 95% confidence interval (CI): 0.598-0.782, specificity 0.488 and sensitivity 0.842] has the best diagnostic efficiency in the "sTfR low level" subgroup. The diagnostic efficiency of sTfR (AUC =0.701, 95% CI: 0.598-0.803, specificity 0.541 and sensitivity 0.797) in the "sTfR high level" subgroup was higher than that of cardiac troponin I (cTnI) (AUC =0.674, 95% CI: 0.564-0.784, specificity 0.719 and sensitivity 0.653). The specific diagnostic methods were as follows: (I) When sTfR ≤1.087 mg/L, calculate the age/sTfR ratio, which indicates the diagnosis of CAD when the result is >58.595; (II) We can directly make a preliminary clinical diagnosis of CAD when sTfR >1.205 mg/L. Except for the above 2 cases, we can initially rule out a diagnosis of CAD.

Conclusions: The iron metabolism index sTfR correlates with CAD morbidity in a "J" shape. With superior diagnostic efficacy than cTnI, sTfR can assist in diagnosing CAD in patients with CAD-like symptoms. In addition, sTfR can provide guidance for the management of body iron levels in CAD patients.

可溶性转铁蛋白受体对疑似冠心病的诊断价值和方法:一项病例对照研究。
背景:许多研究指出,体内铁超载是冠状动脉粥样硬化(AS)的危险因素,也有研究表明,铁缺乏与冠状动脉粥样硬化有关。关于铁代谢如何影响冠状动脉疾病(CAD),目前仍未达成共识。本研究旨在分析铁代谢指标与冠心病之间的关系,探讨可溶性转铁蛋白受体(sTfR)对疑似冠心病的诊断价值,并建立诊断模型:这是一项回顾性研究。方法:这是一项回顾性研究。研究纳入了2022年9月至2023年5月期间在安徽医科大学第二附属医院心血管内科接受冠状动脉造影检查的268名有CAD样症状的患者,这些患者没有其他慢性疾病或相关用药史,并形成了一个连续的系列,包括188名CAD患者和80名对照组。每项铁代谢指标按三等分划分为一个等级变量。为了研究铁代谢指标与 CAD 风险之间的关系,我们对各分层之间的 CAD 发病率进行了比较,并进行了非线性相关检验。我们使用受限立方样条曲线(RCS)绘制了 sTfR 与 CAD 风险之间的关系曲线,并确定了最小几率所对应的 sTfR 值,据此将总样本分为 "sTfR 低水平 "亚组和 "sTfR 高水平 "亚组。逻辑回归分析用于建立这两个亚组的诊断模型。通过接收器操作特征(ROC)分析比较了指标和模型的诊断效率:结果:sTfR与CAD风险呈 "J "型相关。在 "sTfR 低水平 "亚组中,年龄/sTfR 比值[曲线下面积(AUC)=0.690,95% 置信区间(CI):0.598-0.782,特异性 0.488,灵敏度 0.842]的诊断效率最高。在 "sTfR 高水平 "亚组中,sTfR 的诊断效率(AUC =0.701,95% CI:0.598-0.803,特异性 0.541,灵敏度 0.797)高于心肌肌钙蛋白 I(cTnI)(AUC =0.674,95% CI:0.564-0.784,特异性 0.719,灵敏度 0.653)。具体诊断方法如下:(I)当 sTfR ≤1.087 mg/L 时,计算年龄/sTfR 比值,当结果>58.595 时,提示诊断为 CAD;(II)当 sTfR >1.205 mg/L 时,可直接进行 CAD 的临床初步诊断。除上述两种情况外,我们可以初步排除 CAD 的诊断:结论:铁代谢指标sTfR与CAD发病率呈 "J "型相关。与 cTnI 相比,sTfR 具有更好的诊断效果,可以帮助诊断有类似 CAD 症状的患者是否患有 CAD。此外,sTfR 还能为管理 CAD 患者体内的铁水平提供指导。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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