急性心肌梗死患者血清因子与Gensini评分的相关性研究
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摘要
目的:观察急性心肌梗死(AMI)患者血清几丁质酶3样蛋白1(YKL-40)、肌红蛋白(Myo)、脂联素(APN)及脑钠肽(BNP)的变化水平,同时分析Gensini评分与这些表达水平改变的相关性。方法:本实验选取我院2014年12月至2016年12月收治的70例AMI患者作为观察组,并同时选取同期到我院进行健康体检的健康者70例作为对照组。按照冠状动脉病变评分(Gensini评分)将70例AMI患者分为不同评分等级:I组,Gensini评分<40分(n=15);II组,Gensini评分40～60分(n=20);III组,Gensini评分61～80分(n=17);IV组,Gensini评分>80分(n=18)。比较AMI患者与健康对照组中各项血清指标表的差异;比较不同Gensini评分组各项血清指标的变化及相关性分析。结果:两组受试者一般情况差异无统计学意义(P>0.05);两组受试者血清YKL-40、Myo、APN及BNP含量比较,与健康受试者比较AMI患者YKL-40、Myo及BNP水平显著上升,组间差异有统计学意义(P<0.05);与健康受试者比较AMI患者APN水平显著下调,有组间差异(P<0.05);不同Gensini评分的AMI患者血清YKL-40、Myo、APN及BNP含量比较,组间差异有统计学意义(P<0.05),Gensini评分越高,血清YKL-40、Myo、APN及BNP含量与健康受试者差距越大;Pearson相关性分析结果显示,血清YKL-40、Myo及BNP水平与Gensini评分呈正相关(r=0.533,P<0.05;r=0.428,P<0.05;r=0.476,P<0.05);血清APN水平与Gennisi评分呈负相关(r=-0.386,P<0.05)。结论:AMI患者血清YKL-40、Myo、BNP含量高于正常人,而APN含量低于正常人;且YKL-40、Myo、BNP含量越高与Gensini评分越高,而APN含量越高与Gensini评分越低。
Objective: To observe the serum levels of chitinase-3 protein(YKL-40), myoglobin(myo), adiponectin(APN) and acute myocardial infarction(AMI) in patients with AMI Brain natriuretic peptide(BNP), and to analyze the correlation between Gensini score and the change of these expression levels. Methods: 70 patients with AMI who were treated in December 2014 and December 2016 were selected as the observation group, and 70 healthy subjects were selected as the control group. 70 patients with AMI were divided into different grades according to the coronary artery lesion score(Gensini score): group I, Gensini score <40, n=15; group II, Gensini score 40-60, n=20; Gensini score 61-80, n=17; IV group, Gensini score> 80 points, n=18. To compare the differences of serum indexes between AMI patients and healthy controls, and to compare the changes and correlations of serum indexes in different Gensini score groups. Results: There was no significant difference between the two groups(P>0.05). The levels of YKL-40, Myo, APN and BNP in the two groups were significantly higher than those in the healthy subjects(P>0.05). The level of APN in AMI patients was significantly lower than that in healthy subjects(P<0.05). The serum levels of YKL-40 in patients with AMI were significantly higher than those in healthy subjects(P<0.05).The Pearson correlation analysis showed that the difference between the two groups was higher than that of the healthy subjects(r=0.476, P<0.05). Serum levels of YNL-40, Myo and BNP were positively correlated with Gensini score(r=0.533, P<0.05; r=0.428, P <0.05; r=0.476, P <0.05);Serum APN levels were negatively correlated with Gennisi scores(r=-0.386, P<0.05). Conclusion: The content of YKL-40, Myo and BNP in AMI patients was higher than that in normal subjects, while the content of APN was lower than that of normal subjects. The higher the level of YKL-40, Myo and BNP, the higher the Gensini scores are; the higher the APN level, the lower the scores are.
Objective: To observe the serum levels of chitinase-3 protein(YKL-40), myoglobin(myo), adiponectin(APN) and acute myocardial infarction(AMI) in patients with AMI Brain natriuretic peptide(BNP), and to analyze the correlation between Gensini score and the change of these expression levels. Methods: 70 patients with AMI who were treated in December 2014 and December 2016 were selected as the observation group, and 70 healthy subjects were selected as the control group. 70 patients with AMI were divided into different grades according to the coronary artery lesion score(Gensini score): group I, Gensini score <40, n=15; group II, Gensini score 40-60, n=20; Gensini score 61-80, n=17; IV group, Gensini score> 80 points, n=18. To compare the differences of serum indexes between AMI patients and healthy controls, and to compare the changes and correlations of serum indexes in different Gensini score groups. Results: There was no significant difference between the two groups(P>0.05). The levels of YKL-40, Myo, APN and BNP in the two groups were significantly higher than those in the healthy subjects(P>0.05). The level of APN in AMI patients was significantly lower than that in healthy subjects(P<0.05). The serum levels of YKL-40 in patients with AMI were significantly higher than those in healthy subjects(P<0.05).The Pearson correlation analysis showed that the difference between the two groups was higher than that of the healthy subjects(r=0.476, P<0.05). Serum levels of YNL-40, Myo and BNP were positively correlated with Gensini score(r=0.533, P<0.05; r=0.428, P <0.05; r=0.476, P <0.05);Serum APN levels were negatively correlated with Gennisi scores(r=-0.386, P<0.05). Conclusion: The content of YKL-40, Myo and BNP in AMI patients was higher than that in normal subjects, while the content of APN was lower than that of normal subjects. The higher the level of YKL-40, Myo and BNP, the higher the Gensini scores are; the higher the APN level, the lower the scores are.
引文
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[2] Droz C, Grob K. Evaluation of the effect of cardiac rehabilitation on left atrial and left ventricular function and its relationship with changes in arterial stiffness in patients with acute myocardial infarction.[J]. Echocardiography, 2015, 32(3):443-447.
[3] Arain F, Gullestad L, Nymo S, et al. Low YKL-40 in chronic heart failure may predict beneficial effects of statins: analysis from the controlled rosuvastatin multinational trial in heart failure (CORONA)[J]. Biomarkers, 2017, 22(3-4):261-267.
[4] 刘欣. cTnI、Myo、CK -MB 联合检测在急性心肌梗死早期诊断中的价值[J]. 河南医学研究, 2016, 25(5):914-915.
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[6] Chen Y L, Sun C K, Tsai T H, et al. Adipose-derived mesenchymal stem cells embedded in platelet-rich fibrin scaffolds promote angiogenesis, preserve heart function, and reduce left ventricular remodeling in rat acute myocardial infarction[J]. American Journal of Translational Research, 2015, 7(5):781-803.
[7] 中华医学会心血管病学分会. 急性心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2001, 16(12):710-725.
[8] 李卉. 急性心肌梗死药物治疗进展[J]. 中国误诊学杂志, 2016, 10(24):8582-8583.
[9] Bjrn M E, Andersen C L, Jensen M K, et al. Circulating YKL‐40 in myelofibrosis a potential novel biomarker of disease activity and the inflammatory state[J]. Europ J Haematol, 2015, 93(3):224-228.
[10] Harutyunyan M, Johansen J S, Mygind N D, et al. Serum YKL-40 for monitoring myocardial ischemia after revascularization in patients with stable coronary artery disease.[J]. Biomark Med, 2014, 8(8):977-987.
[11] Kjaergaard A D, Johansen J S, Bojesen S E, et al. Role of inflammatory marker YKL-40 in the diagnosis, prognosis, and cause of cardiovascular and liver diseases[J]. Critical Reviews in Clinical Laboratory Sciences, 2016, 53(6):1.
[12] 郑相慧, 武维恒, 巩雷,等. 急性冠状动脉综合征患者相关炎性因子水平变化及临床意义[J]. 中华老年心脑血管病杂志, 2015(3):253-257.
[13] 倪文娟, 王玮, 王云枝. 分析血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的关系[J]. 糖尿病新世界, 2016, 19(2):94-96.
[14] Otsuka M, Minami S, Hato K, et al. Acute myocardial infarction caused by thrombotic occlusion of a coronary aneurysm[J]. Catheterization & Cardiovascular Diagnosis, 2015, 41(4):423-425.
[15] 杨人强,程晓曙,苏海,等. 质子泵抑制剂对老年急性心肌梗死患者抗栓治疗中消化道出血的预防作用[J]. 心肺血管病杂志,2010,29(S1):66.
[16] 师静梅, 廉秋芳, 梁引红,等. 脂联素与急性ST段抬高型心肌梗死患者冠状动脉病变程度的相关性研究[J]. 中国实用医刊, 2017(23):10-12.
[17] Medina A, Moss A J, Mcnitt S, et al. Brain natriuretic peptide and the risk of ventricular tachyarrhythmias in mildly symptomatic heart failure patients enrolled in MADIT-CRT.[J]. Heart Rhythm, 2016, 13(4):852-859.
[18] Alexander D, Klaus S, Zimmermann M E, et al. NT-proBNP predicts cardiovascular death in the general population independent of left ventricular mass and function: insights from a large population-based study with long-term follow-Up[J]. Plos One, 2016, 11(10):e0164060.
[2] Droz C, Grob K. Evaluation of the effect of cardiac rehabilitation on left atrial and left ventricular function and its relationship with changes in arterial stiffness in patients with acute myocardial infarction.[J]. Echocardiography, 2015, 32(3):443-447.
[3] Arain F, Gullestad L, Nymo S, et al. Low YKL-40 in chronic heart failure may predict beneficial effects of statins: analysis from the controlled rosuvastatin multinational trial in heart failure (CORONA)[J]. Biomarkers, 2017, 22(3-4):261-267.
[4] 刘欣. cTnI、Myo、CK -MB 联合检测在急性心肌梗死早期诊断中的价值[J]. 河南医学研究, 2016, 25(5):914-915.
[5] 薛剑,马明军,臧秀敏,等. 甲状腺激素水平对急性心肌梗死后心力衰竭发生的预测价值[J]. 心肺血管病杂志,2017,36(12):996-998.
[6] Chen Y L, Sun C K, Tsai T H, et al. Adipose-derived mesenchymal stem cells embedded in platelet-rich fibrin scaffolds promote angiogenesis, preserve heart function, and reduce left ventricular remodeling in rat acute myocardial infarction[J]. American Journal of Translational Research, 2015, 7(5):781-803.
[7] 中华医学会心血管病学分会. 急性心肌梗死诊断和治疗指南[J]. 中华心血管病杂志, 2001, 16(12):710-725.
[8] 李卉. 急性心肌梗死药物治疗进展[J]. 中国误诊学杂志, 2016, 10(24):8582-8583.
[9] Bjrn M E, Andersen C L, Jensen M K, et al. Circulating YKL‐40 in myelofibrosis a potential novel biomarker of disease activity and the inflammatory state[J]. Europ J Haematol, 2015, 93(3):224-228.
[10] Harutyunyan M, Johansen J S, Mygind N D, et al. Serum YKL-40 for monitoring myocardial ischemia after revascularization in patients with stable coronary artery disease.[J]. Biomark Med, 2014, 8(8):977-987.
[11] Kjaergaard A D, Johansen J S, Bojesen S E, et al. Role of inflammatory marker YKL-40 in the diagnosis, prognosis, and cause of cardiovascular and liver diseases[J]. Critical Reviews in Clinical Laboratory Sciences, 2016, 53(6):1.
[12] 郑相慧, 武维恒, 巩雷,等. 急性冠状动脉综合征患者相关炎性因子水平变化及临床意义[J]. 中华老年心脑血管病杂志, 2015(3):253-257.
[13] 倪文娟, 王玮, 王云枝. 分析血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的关系[J]. 糖尿病新世界, 2016, 19(2):94-96.
[14] Otsuka M, Minami S, Hato K, et al. Acute myocardial infarction caused by thrombotic occlusion of a coronary aneurysm[J]. Catheterization & Cardiovascular Diagnosis, 2015, 41(4):423-425.
[15] 杨人强,程晓曙,苏海,等. 质子泵抑制剂对老年急性心肌梗死患者抗栓治疗中消化道出血的预防作用[J]. 心肺血管病杂志,2010,29(S1):66.
[16] 师静梅, 廉秋芳, 梁引红,等. 脂联素与急性ST段抬高型心肌梗死患者冠状动脉病变程度的相关性研究[J]. 中国实用医刊, 2017(23):10-12.
[17] Medina A, Moss A J, Mcnitt S, et al. Brain natriuretic peptide and the risk of ventricular tachyarrhythmias in mildly symptomatic heart failure patients enrolled in MADIT-CRT.[J]. Heart Rhythm, 2016, 13(4):852-859.
[18] Alexander D, Klaus S, Zimmermann M E, et al. NT-proBNP predicts cardiovascular death in the general population independent of left ventricular mass and function: insights from a large population-based study with long-term follow-Up[J]. Plos One, 2016, 11(10):e0164060.