摘要
目的:本实验旨在研究急性冠脉综合征(ACS)和稳定性心绞痛(SAP)患者血清抵抗素水平与其心血管危险因素以及冠状动脉病变严重程度之间的相关性。
背景:抵抗素是近年来被发现的一种脂肪细胞因子,与肥胖和胰岛素抵抗密切相关。研究表明抵抗素可影响内皮细胞功能、增强黏附分子表达和刺激血管平滑肌细胞迁移。但目前尚无文献报道抵抗素与急性冠脉综合征的相关性。
方法:220例受试者依据病史、心电图(ECG)检查、活动平板运动试验((ETT)、心肌酶谱和心肌肌钙蛋白I检测以及冠状动脉造影术后,被分为正常对照组、SAP组和ACS组。基本临床资料包括身高、体重、腰围、腹围、外周血白细胞(WBC)值、高敏C反应蛋白(hsCRP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-c)、高密度脂蛋白胆固醇(HDL-c)、吸烟及饮酒习惯均由一名心内科医师收集并整理。患者的身高、体重、腰围、腹围等资料在入院时检测,而患者外周血WBC水平、hsCRP水平和血脂水平由新桥医院检验科测定。市售人抵抗素酶联免疫吸附法(ELISA)试剂盒测定患者血清抵抗素水平。
结果:
(1)正常对照组、SAP组和ACS组之间,受试者血清抵抗素水平统计学上具有明显差异,并且ACS组患者血清抵抗素水平远远高于SAP组和正常对照组(ACS vs. SAP/Controls: 1.18 vs. 0.66/0.49 ng/ml, p<0.01)。在对整个受试人群严格按照年龄和性别配对后行t检验, ACS组患者血清抵抗素水平仍然高于SAP组和正常对照组(ACS vs. SAP/Controls: 1.16 vs. 0.72/0.49 ng/ml, p<0.01)。
(2)受试人群的血清抵抗素水平与其年龄(r=0.212, p=0.002)、体重指数(BMI)(r=0.186, p=0.006)、腰臀围比(WHR) (r=0.236, p=0.0004)、外周血WBC值(r=0.342, p<0.001)、hsCRP水平(r=0.362, p<0.001)、TG(r=0.170, p=0.012)和LDL-c(r=0.178, p=0.008)水平之间呈正相关,而与HDL-c(r=-0.268, p<0.001)水平之间呈负相关性。
(3)分别在上述三组中分析血清抵抗素水平与心血管危险因素之间的相关性时,我们发现只有在急性冠脉综合征组患者中,血清抵抗素水平才与外周血WBC水平(r=0.347, p=0.001)和hsCRP水平(r=0.262, p=0.004)之间具有显著的相关性。
(4)同时还发现血清抵抗素水平与>50%狭窄的冠状动脉数之间具有显著相关性并且血清抵抗素水平随>50%狭窄的冠状动脉数的增多而增高(p<0.01)。同时多项分类logistic回归分析发现血清抵抗素水平在ACS中是一项强的危险因素(OR 29.132,95%CI:10.939-77.581,P<0.001)。
结论:本实验研究发现血清抵抗素水平在三组患者统计学上具有明显差异并且ACS患者血清抵抗素水平远高于前两组;血清抵抗素水平与心血管危险因素如肥胖、血脂、炎症反应之间具有明显相关性。并且血清抵抗素水平与冠状动脉病变严重程度之间具有明显相关性。这些结果均支持抵抗素作为一项强的危险因素参与动脉粥样硬化的形成过程尤其是参与ACS的发病过程。
Objectives: We sought to evaluate the correlation between serum resistin levels, cardiovascular risk factors, and the severity of coronary stenosis in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS).
Background: Resistin is a recently identified adipocytokine which is strongly correlated with obesity and insulin resistance. Resistin is reported to enhance the expression of adhension molecules, affect endothelial function, and stimulate vascular smooth muscle cells migration. But few population-based data are available from subjects in ACS solely.
Method: A total of 220 consecutive patients, who were evaluated by clinical history, electrocardiography (ECG), exercise tolerance tests (ETT), blood test and coronary angiography, were divided into normal control group, SAP group, and ACS group. Baseline clinical characteristics, including height, weight, waist circumference, hip circumference, white blood cells (WBC) counts, high-sensitive C-reactive protein (hsCRP) levels, total cholesterol (TC) levels, triglycerides (TG) levels, low-density lipoprotein cholesterol (LDL-c) levels, high-density lipoprotein cholesterol (HDL-c) levels, smoking habit and drinking habit, were collected prospectively by a dedicated cardiologist. The height, weight, waist circumference, and hip circumference of patients were measured when they enrolled in our institution. The WBC counts, hsCRP levels, and serum lipids levels were measured by the laboratory department of XinQiao hospital. Commercially available ELISA kits were used to detect serum resistin levels.
Results:
(1) There was significant difference in serum resistin levels between normal controls, SAP patients and ACS ones, while serum resistin levels were extremely high in ACS group (ACS vs. SAP/Controls: 1.18 vs. 0.66/0.49 ng/ml, p<0.01). After adusting for age and sex in patients, paired-samples t test showed that serum resistin levels in ACS group remained significantly higher than those in SAP group and control group (ACS vs. SAP/Controls: 1.16 vs. 0.72/0.49 ng/ml, p<0.01).
(2) Serum resistin levels were associated with age (r=0.212, p=0.002), body mass index (BMI) (r=0.186, p=0.006), waist-to-hip ratio (WHR) (r=0.236, p=0.0004), WBC counts (r=0.342, p<0.001), hsCRP levels (r=0.362, p<0.001), TG (r=0.170, p=0.012), LDL-c (r=0.178, p=0.008) and HDL-c levels (r=-0.268, p<0.001).
(3) When testing the correlation between serum resistin levels and cardiovascular risk factors in the three groups respectively, only in ACS group, serum resistin levels were remarkably associated with WBC counts (r=0.347, p=0.001), and hsCRP levels (r=0.262, p=0.004).
(4) Furthermore, serum resistin levels showed correlation and stepwise increase with the numbers of >50% stenotic coronary vessels (p<0.01). Multinomial logistic regression test demonstrated that serum resistin levels were a strong risk factor in ACS (OR 29.132,95%CI:10.939-77.581,P<0.001).
Conclusion: It can be concluded that, in our study population, serum resistin levels vary significantly in three different diagnosis groups and are extremely high in ACS patients. Moreover, serum resistin levels are highly correlated with atherosclerotic risk factors such as obesity, serum lipids, and systemic inflammation markers. Serum resistin levels are correlated with the severity of coronary stenosis and dependant on the number of >50% stenotic vessels. These findings support the potential role of resistin as a strong risk factor in the development of atherosclerosis and especially its involvement in the progress of ACS.
引文
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25. Kawanami D, Maemura K, Takeda N, et al .Direct reciprocal effects of resistin and adiponectin on vascular endothelial cells: a new insight into adipocytokine-endothelial cell interactions. Biochem Biophy Res Commun, 2004; 314: 415-419.
26. Verma S, Li SH, Wang CH, et al. Resistin promotes endothelial cell activation .Further evidence of adipokine –endothelial interaction. Circulation, 2003; 108: 736-740.
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