[血清γ-谷氨酰转移酶活性：冠状动脉搭桥术疾病的一种新标志物]

[Serum gamma-glutamyltransferase activity: a new marker for coronary artery bypass graft disease].

作者信息

Ulus Taner, Yıldırır Aylin, Sade Leyla Elif, Balta Sevket, Ozin Bülent, Sezgin Atilla, Müderrisoğlu Haldun

机构信息

Department of Cardiology, Medicine Faculty of Başkent University, Ankara, Turkey.

出版信息

Turk Kardiyol Dern Ars. 2011 Apr;39(3):205-13. doi: 10.5543/tkda.2011.01243.

DOI:10.5543/tkda.2011.01243

PMID:21532296

Abstract

OBJECTIVES

Serum gamma-glutamyltransferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. We evaluated the association between GGT and severe graft disease in patients undergoing coronary artery bypass graft (CABG) surgery.

STUDY DESIGN

We evaluated 113 patients (mean age 62±9 years; range 21 to 81 years) who underwent control coronary angiography after a mean of 39 months (range 18 to 84 months) following CABG surgery. A graft was considered patent if there was <70% stenosis or severely diseased if there was ≥70% stenosis on coronary angiography. Preoperative serum GGT levels were measured in all the patients and none had severe systemic or hepatobiliary disease. The association between serum GGT level and severe graft disease was investigated. The grafts were also evaluated separately.

RESULTS

Coronary angiography showed severe graft disease involving at least one graft in 65 patients (57.5%). Serum GGT level was significantly higher in patients with severe graft disease (p=0.001). ROC curve analysis yielded a cut-off value of 29.5 U/l for serum GGT level to predict severe graft disease (area under the curve: 0.69) with 48% sensitivity and 82% specificity. While GGT levels were similar for internal mammary artery grafts (p>0.05), radial artery grafts and saphenous vein grafts (SVG) with severe graft disease were associated with significantly higher GGT levels (p=0.003 and p<0.001, respectively). In multivariate analysis, family history of coronary artery disease at a young age (OR 2.46, 95% CI 1.08-5.61, p=0.03) and serum GGT (OR 1.03, 95% CI 1.00-1.07, p=0.05) were independent predictors of severe graft disease. Separate analysis based on the graft types showed that GGT was an independent predictor of severe graft disease for only SVG (OR 1.02, 95% CI 1.00-1.04, p=0.03).

CONCLUSION

Serum GGT level may be an independent marker for the development of severe SVG disease in patients undergoing CABG surgery.

摘要

目的

血清γ-谷氨酰转移酶（GGT）活性已被证明与动脉粥样硬化的发展和心血管事件有关。我们评估了接受冠状动脉旁路移植术（CABG）的患者中GGT与严重移植血管病变之间的关联。

研究设计

我们评估了113例患者（平均年龄62±9岁；范围21至81岁），这些患者在CABG手术后平均39个月（范围18至84个月）接受了冠状动脉造影检查。如果冠状动脉造影显示狭窄<70%，则认为移植血管通畅；如果狭窄≥70%，则认为移植血管严重病变。所有患者均测量了术前血清GGT水平，且均无严重的全身性或肝胆疾病。研究了血清GGT水平与严重移植血管病变之间的关联。对移植血管也进行了单独评估。

结果

冠状动脉造影显示65例患者（57.5%）存在至少一根移植血管的严重病变。严重移植血管病变患者的血清GGT水平显著更高（p=0.001）。ROC曲线分析得出血清GGT水平预测严重移植血管病变的临界值为29.5 U/l（曲线下面积：0.69），敏感性为48%，特异性为82%。虽然乳内动脉移植血管的GGT水平相似（p>0.05），但严重病变的桡动脉移植血管和大隐静脉移植血管（SVG）的GGT水平显著更高（分别为p=0.003和p<0.001）。在多变量分析中，年轻时的冠心病家族史（OR 2.46，95%CI 1.08 - 5.61，p=0.03）和血清GGT（OR 1.03，95%CI 1.00 - 1.07，p=0.05）是严重移植血管病变的独立预测因素。基于移植血管类型的单独分析显示，GGT仅是SVG严重移植血管病变的独立预测因素（OR 1.02，95%CI 1.00 - 1.04，p=0.03）。