血清淀粉样蛋白A与冠心病的相关性研究
|
摘要
目的探讨血清淀粉样蛋白A(SAA)与冠状动脉粥样硬化性心脏病(冠心病,CHD)患者的诊断、病变程度及预后的相关性。方法收集CHD患者共118例,包括46例AMI患者(AMI组)、38例不稳定性心绞痛患者(UA组)、34例稳定性心绞痛患者(SA组)以及30例正常对照者(正常对照组),分别检测4组患者的SAA、CRP、降钙素原、IL-6、高敏肌钙蛋白T(hs-TnT)、CK-MB、肌红蛋白、血清脑钠肽前体(NT-ProBNP)水平及CHD组的HDL-C、LDL-C、总胆固醇、甘油三酯和脂蛋白a;采用Pearson法分析SAA同上述指标及CHD危险因素和Gensini评分的相关性。结果①CHD组的SAA、IL-6、降钙素原的水平高于正常对照组(P<0.05),并且呈现AMI组>UA组>SA组的趋势,且在冠状动脉单支病变、双支病变、多支病变者逐渐增高。CRP在AMI组的水平高于正常对照组(P <0.05),但在其它任意2组间差异无统计学意义(P均> 0.05)。②AMI组、UA组的hs-TnT、NT-ProBNP、CK-MB、肌红蛋白的水平高于正常对照组及SA组(P均<0.05),呈现AMI组>UA组>SA组的趋势,而在SA组与正常对照组间差异无统计学意义;在冠状动脉病变程度上也无明显差异(P> 0.05)。③SAA与IL-6、降钙素原、CRP、甘油三酯的水平呈正相关,与LDL-C水平呈负相关,与Gensini评分在AMI组及UA组呈正相关,而在SA组无相关性。结论 SAA对于CHD的临床辅助识别的敏感性较高,对筛查高危人群、CHD病情的观察及判断其预后有一定的临床意义。
Objective To investigate the correlation between the serum amyloid A(SAA) and the diagnosis, severity and prognosis of patients with coronary heart disease(CHD). Methods A total of 118 CHD patients were recruited in this study, including forty-six cases of acute myocardial infarction(AMI), 38 patients diagnosed with unstable angina pectoris(UA), 34 cases of stable angina pectoris(SA). 30 healthy people were as normal controls. The SAA, C-reactive protein(CRP), calcitonin(PCT), interleukin 6(IL-6), hs-TnT(cardiac troponin T), CK-MB(creatine kinase), MYO(myoglobin), NT-ProBNP(B-type natriuretic) of patients in four groups and the high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), total cholesterin(CHO), triglyceride(TG), lipoprotein a(LPa) of patients in the CHD group were quantitatively detected. The correlation between the SAA and the above indexes, risk factors of coronary heart disease and Gensini scores were analyzed by Pearson's correlation analysis. Results The levels of SAA, IL-6 and PCT in patients with CHD were significantly higher than those in the control group(all P < 0.05), and showed a trend of AMI>UA>SA, and increased in the patients with coronary artery disease alone, coronary artery double branch disease and multiple coronary artery disease. The CRP level in the AMI group was significantly higher than that in the normal control group(P < 0.05), but there was no significant difference between the other two groups(P > 0.05). The levels of hs-TnT, NT-ProBNP, CK-MB and MYO in the patients with AMI and UA were significantly higher compared with those in the normal control and SA groups(all P < 0.05), showing the trend of AMI>UA>SA, but there was no statistical difference between the SA and normal control groups. No statistical significance was noted in the degree of coronary artery disease(P > 0.05). SAA was positively correlated with the levels of IL-6, PCT, CRP and TG, whereas negatively correlated with the LDL-C level. There was a positive correlation with the Gensini scores in the AMI and UA groups, but no correlation was detected in the SA group. Conclusions SAA is highly sensitive to the clinical adjuvant diagnosis of CHD. It is of certain clinical significance in screening of the high-risk population, predicting and evaluating the clinical prognosis of CHD patients.
Objective To investigate the correlation between the serum amyloid A(SAA) and the diagnosis, severity and prognosis of patients with coronary heart disease(CHD). Methods A total of 118 CHD patients were recruited in this study, including forty-six cases of acute myocardial infarction(AMI), 38 patients diagnosed with unstable angina pectoris(UA), 34 cases of stable angina pectoris(SA). 30 healthy people were as normal controls. The SAA, C-reactive protein(CRP), calcitonin(PCT), interleukin 6(IL-6), hs-TnT(cardiac troponin T), CK-MB(creatine kinase), MYO(myoglobin), NT-ProBNP(B-type natriuretic) of patients in four groups and the high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), total cholesterin(CHO), triglyceride(TG), lipoprotein a(LPa) of patients in the CHD group were quantitatively detected. The correlation between the SAA and the above indexes, risk factors of coronary heart disease and Gensini scores were analyzed by Pearson's correlation analysis. Results The levels of SAA, IL-6 and PCT in patients with CHD were significantly higher than those in the control group(all P < 0.05), and showed a trend of AMI>UA>SA, and increased in the patients with coronary artery disease alone, coronary artery double branch disease and multiple coronary artery disease. The CRP level in the AMI group was significantly higher than that in the normal control group(P < 0.05), but there was no significant difference between the other two groups(P > 0.05). The levels of hs-TnT, NT-ProBNP, CK-MB and MYO in the patients with AMI and UA were significantly higher compared with those in the normal control and SA groups(all P < 0.05), showing the trend of AMI>UA>SA, but there was no statistical difference between the SA and normal control groups. No statistical significance was noted in the degree of coronary artery disease(P > 0.05). SAA was positively correlated with the levels of IL-6, PCT, CRP and TG, whereas negatively correlated with the LDL-C level. There was a positive correlation with the Gensini scores in the AMI and UA groups, but no correlation was detected in the SA group. Conclusions SAA is highly sensitive to the clinical adjuvant diagnosis of CHD. It is of certain clinical significance in screening of the high-risk population, predicting and evaluating the clinical prognosis of CHD patients.
引文
[1]朱国富,李希杰,阮志敏,张明国,武力勇,张倩,周明礼,章然,郑梅,楚天舒.血清淀粉样蛋白A与老年冠心病患者冠状动脉病变严重程度的相关性分析.中华老年心脑血管病杂志,2016,18(11):1161-1164.
[2]刘军妮,徐冬玲,杜贻萌,姚桂华,蒋卫东,赵敬杰,董兆强,隋树建,王欣,鹿庆华.血清脂蛋白相关磷脂酶A2与冠状动脉粥样硬化斑块稳定性的相关研究——附107例报告.新医学,2009,40(1):18-20,46.
[3]DavìG, Patrono C. Platelet activation and atherothrombosis. N Engl Med, 2007,357(24):2482-2494.
[4]Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflmmation in atherosclerosis:from pathophysiology to practice.J Am Coll Cardiol,2009,54(23):2129-2138.
[5]Sadowitz B, Maier KG, Gahtan V. Basic science review:Statin therapy--Part I:the pleiotropic effects of statins in cardiovascular diease.Vasc Endovascular Surg, 2010,44(4):241-251.
[6]Chan B, Barrie N,Cai X, Wang X,PaulM,Morton-Chandra R,Sharland A,Dennis JM,Freedman SB,Witting PK. Serum amyloid A receptor blockade and incorporation into high-density lipoprotein modulates its pro-inflammatory and pro-thrombotic activities on vascular endothelial cells. Int J Mol Sci,2015,16(5):11101-11124.
[7]Chen GL, Liu LW, Xie S, Liu H,Liu YQ,Li YS. Highdensity lipoprotein associated factors apoA-I and serum amyloid A in Chinese nondiabetic patients with coronary heart disease.Chin Med J(Engl), 2010, 123(6):658-663.
[8]Wang DX, Liu H, Yan LR, Zhang YP,Guan XY,Xu ZM,Jia YH,Li YS. The relationship between serum amyloid A and apolipoprotein A-I in high-density lipoprotein isolated from patients with coronary heart diease. Chin Med J(Engl), 2013,126(19):3656-3661.
[9]Zewinger S, Drechsler C, Kleber ME, Dressel A,Riffel J,Triem S,Lehmann M,Kopecky C,S?emann MD,Lepper PM,Silbernagel G,Scharnagl H,Ritsch A,Thorand B,de las hersa gala T,Wagenpfeil S,Koenig W,Peters A,Laufs U,Wanner C,Fliser D,Speer T,M?rz W. Serum amyloid A:high-density lipopro-teins interaction and cardiovascular risk.Eur Hear J, 2015,36(43):3007-3016.
[10]Denard J, Marolleau B, Jenny C,Rao TN,Fehling HJ,Viot T,Svinartchouk F.C-reactive protein is essential for efficient systemic transduction of recombinant adeno-associlted virus vector 1(rAAV-1)and Raav-6 in mice.J Virol,2013, 87(19):10784-10791.
[2]刘军妮,徐冬玲,杜贻萌,姚桂华,蒋卫东,赵敬杰,董兆强,隋树建,王欣,鹿庆华.血清脂蛋白相关磷脂酶A2与冠状动脉粥样硬化斑块稳定性的相关研究——附107例报告.新医学,2009,40(1):18-20,46.
[3]DavìG, Patrono C. Platelet activation and atherothrombosis. N Engl Med, 2007,357(24):2482-2494.
[4]Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflmmation in atherosclerosis:from pathophysiology to practice.J Am Coll Cardiol,2009,54(23):2129-2138.
[5]Sadowitz B, Maier KG, Gahtan V. Basic science review:Statin therapy--Part I:the pleiotropic effects of statins in cardiovascular diease.Vasc Endovascular Surg, 2010,44(4):241-251.
[6]Chan B, Barrie N,Cai X, Wang X,PaulM,Morton-Chandra R,Sharland A,Dennis JM,Freedman SB,Witting PK. Serum amyloid A receptor blockade and incorporation into high-density lipoprotein modulates its pro-inflammatory and pro-thrombotic activities on vascular endothelial cells. Int J Mol Sci,2015,16(5):11101-11124.
[7]Chen GL, Liu LW, Xie S, Liu H,Liu YQ,Li YS. Highdensity lipoprotein associated factors apoA-I and serum amyloid A in Chinese nondiabetic patients with coronary heart disease.Chin Med J(Engl), 2010, 123(6):658-663.
[8]Wang DX, Liu H, Yan LR, Zhang YP,Guan XY,Xu ZM,Jia YH,Li YS. The relationship between serum amyloid A and apolipoprotein A-I in high-density lipoprotein isolated from patients with coronary heart diease. Chin Med J(Engl), 2013,126(19):3656-3661.
[9]Zewinger S, Drechsler C, Kleber ME, Dressel A,Riffel J,Triem S,Lehmann M,Kopecky C,S?emann MD,Lepper PM,Silbernagel G,Scharnagl H,Ritsch A,Thorand B,de las hersa gala T,Wagenpfeil S,Koenig W,Peters A,Laufs U,Wanner C,Fliser D,Speer T,M?rz W. Serum amyloid A:high-density lipopro-teins interaction and cardiovascular risk.Eur Hear J, 2015,36(43):3007-3016.
[10]Denard J, Marolleau B, Jenny C,Rao TN,Fehling HJ,Viot T,Svinartchouk F.C-reactive protein is essential for efficient systemic transduction of recombinant adeno-associlted virus vector 1(rAAV-1)and Raav-6 in mice.J Virol,2013, 87(19):10784-10791.