急性ST段抬高型心肌梗死患者血清趋化素水平与血栓负荷相关性的探讨
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摘要
目的:探讨急性ST段抬高型心肌梗死(STEMI)患者血清趋化素(chemerin)水平与血栓负荷的相关性。方法:入选行急诊PCI治疗的STEMI患者80例,另选取年龄、性别匹配的行冠状动脉(冠脉)造影的稳定性心绞痛患者30例为对照组;评估患者的冠脉内血栓负荷程度和Gensini评分;采用酶联免疫吸附法及免疫散射比浊法分别测定血清chemerin及高敏C反应蛋白(hs-CRP)水平;评估左室射血分数(left ventricular ejection fraction,LVEF)。结果:与对照组相比,STEMI患者的血清chemerin和hs-CRP的水平明显升高[(153.2±15.3)ng/ml∶(134.3±10.4)ng/ml,(12.0±4.8)mg/L∶(5.4±3.4)mg/L,P<0.05];在STEMI组,与低血栓负荷组相比,血栓负荷高的患者chemerin、hs-CRP、高敏心肌肌钙蛋白T(hs-cTnT)峰值水平及PCI后TIMI帧数均明显升高[(158.3±16.7)ng/ml∶(140.2±9.6)ng/ml,(13.2±3.6)mg/L∶(9.2±2.0)mg/L,(5 447.2±189.1)pg/ml∶(3 560.3±243.2)pg/ml,(37.4±13.6)∶(31.5±10.6),P<0.05];而LVEF明显降低[(48.4±8.2)%∶(53.5±7.7)%,P<0.05];相关性分析显示血清chemerin水平和hs-CRP(r=0.45,P<0.001)、hs-cTnT峰值(r=0.38,P<0.001)水平呈显著相关性。结论:血栓负荷和炎症水平较高的STEMI患者的chemerin水平较高。
Objective:To investigate serum chemerin levels in ST elevation myocardial infarction(STEMI)patients and find out possible relationships between chemerin levels and thrombus burden.Method:Eighty consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention(PCI)with coronary stents implantation were enrolled,and 30age-and sex-matched patients with stable angina pectoris who underwent coronary angiography formed the control group.Angiographic characteristics of the patients including thrombolysis in myocardial infarction(TIMI)thrombus and Gensini scores were noted.Chemerin and hypersensitive C-reactive protein(hs-CRP)levels were determined by enzyme-linked immunosorbent method(ELISA)and immuno turbidimetry in serum of each group,respectively.Their cardiac function were assessed.Result:Serum chemerin and hs-CRP levels were significantly increased in patients with STEMI[(153.2±15.3)ng/ml∶(134.3±10.4)ng/ml,(12.0±4.8)mg/L∶(5.4±3.4)mg/L,P<0.05].Among STEMI patients,serum chemerin and hs-CRP and peak hs-cTnT levels and post-PCI TIMI frame count were significantly higher in patients with high thrombus burden[(158.3±16.7)ng/ml∶(140.2±9.6)ng/ml,(13.2±3.6)mg/L∶(9.2±2.0)mg/L,(5 447.2±189.1)pg/ml∶(3 560.3±243.2)pg/ml,(37.4±13.6)∶(31.5±10.6),P<0.05];while left ventricular ejection fraction were lower[(48.4±8.2)% ∶(53.5±7.7)%,P<0.05];Besides,serum chemerin levels were also found to be significantly correlated with hs-CRP(r=0.45,P<0.001)and peak hs-cTnT(r=0.38,P<0.001)levels.Conclusion:Results from our study have demonstrated that chemerin levels were higher in STEMI patients with greater thrombus burden and higher level of inflammation.
Objective:To investigate serum chemerin levels in ST elevation myocardial infarction(STEMI)patients and find out possible relationships between chemerin levels and thrombus burden.Method:Eighty consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention(PCI)with coronary stents implantation were enrolled,and 30age-and sex-matched patients with stable angina pectoris who underwent coronary angiography formed the control group.Angiographic characteristics of the patients including thrombolysis in myocardial infarction(TIMI)thrombus and Gensini scores were noted.Chemerin and hypersensitive C-reactive protein(hs-CRP)levels were determined by enzyme-linked immunosorbent method(ELISA)and immuno turbidimetry in serum of each group,respectively.Their cardiac function were assessed.Result:Serum chemerin and hs-CRP levels were significantly increased in patients with STEMI[(153.2±15.3)ng/ml∶(134.3±10.4)ng/ml,(12.0±4.8)mg/L∶(5.4±3.4)mg/L,P<0.05].Among STEMI patients,serum chemerin and hs-CRP and peak hs-cTnT levels and post-PCI TIMI frame count were significantly higher in patients with high thrombus burden[(158.3±16.7)ng/ml∶(140.2±9.6)ng/ml,(13.2±3.6)mg/L∶(9.2±2.0)mg/L,(5 447.2±189.1)pg/ml∶(3 560.3±243.2)pg/ml,(37.4±13.6)∶(31.5±10.6),P<0.05];while left ventricular ejection fraction were lower[(48.4±8.2)% ∶(53.5±7.7)%,P<0.05];Besides,serum chemerin levels were also found to be significantly correlated with hs-CRP(r=0.45,P<0.001)and peak hs-cTnT(r=0.38,P<0.001)levels.Conclusion:Results from our study have demonstrated that chemerin levels were higher in STEMI patients with greater thrombus burden and higher level of inflammation.
引文
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[7]孟利民,杨华,常超,等.重组人脑钠肽对急性心肌梗死患者急诊介入后血清趋化素和白细胞介素37的影响[J].中华老年心脑血管病杂志,2018,(20)4:378-381.
[8]中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):675-690.
[9] Gensini GG,A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606-606.
[10]Topaz O.Comparison between thrombus removal devices:aspirations meet reality[J].Catheter Cardiovasc Interv,2011,78(1):20-22.
[11]李宏松,许向东,吴国林,等.ST段抬高型心肌梗死患者急诊PCI术中选择性使用血栓抽吸策略的研究[J].临床心血管病杂志,2017,33(10):946-949.
[12]Chen J,Cui L,Yuan J,et al.Protective effect of diminazene attenuates myocardial infarction in rats via increased inflammation and ACE2activity[J].Mol Med Rep,2017,16(4):4791-4796.
[13]Ray KK,Cannon CP.The potential relevance of the multiple lipid-independent(pleiotropic)effects of statins in the management of acute coronary syndromes[J].J Am Coll Cardiol,2005,46(8):1425-1433.
[14]Wan Q,Cui X,Shao J,et al.Beijing ambient particle exposure accelerates atherosclerosis in ApoE knockout mice by upregulating visfatin expression[J].Cell Stress Chaperones,2014,19(5):715-724.
[15] Huang CL,Wu YW,Wu CC,et al.Association between serum adipocyte fatty-acid binding protein concentrations,left ventricular function and myocardial perfusion abnormalities in patients with coronary artery disease[J].Cardiovasc Diabetol,2013,12:105.
[16]金鑫,韩朝鑫,王彦富,等.趋化因子CCL21及其受体CCR7与冠状动脉易损斑块的相关性研究[J].临床心血管病杂志,2015,31,(12):1293-1296.
[17]Trepels T,Zeiher AM,Fichtlscherer S,et al.Acute coronary syndrome and inflammation.Biomarkers for diagnostics and risk stratification[J].Herz,2004,29(8):769-776.
[18]Niccoli G,Menozzi A,Capodanno D,et al.Relationship betweenseruminflammatorybiomarkersand thrombus characteristics in patients with ST segment elevation myocardial infarction[J].Cardiology,2017,137(1):27-35.
[19]Inci S,Aksan G,Do?an P.Chemerin as an independent predictor of cardiovascular event risk[J].Ther Adv Endocrinol Metab,2016,7(2):57-68.
[20]熊玮,董少红,张键,等.趋化素促进小鼠血管平滑肌细胞增殖的实验研究[J].临床心血管病杂志,2016,32(1):66-69.
[2] Ferland DJ,Watts SW.Chemerin:A comprehensive review elucidating the need for cardiovascular research[J].Pharmacol Res,2015,99:351-361.
[3] Roman AA,Parlee SD,and Sinal CJ.Chemerin:apotential endocrine link between obesity and type 2diabetes[J].Endocrine,2012,42(2):243-251.
[4] Goralski KB,McCarthy TC,Hanniman EA,et al.Chemerin,a novel adipokine that regulates adipogenesis and adipocyte metabolism[J].J Biol Chem,2007,282(38):28175-28188.
[5] Lehrke M,Becker A,Greif M,et al.Chemerin is associated with markers of inflammation and components of the metabolic syndrome but does not predict coronary atherosclerosis[J].Eur J Endocrinol,2009,161(2):339-344.
[6] Inci S,Aksan G,Dogan P.Chemerin as an independent predictor of cardiovascular event risk[J].Ther Adv Endocrinol Metab,2016,7(2):57-68.
[7]孟利民,杨华,常超,等.重组人脑钠肽对急性心肌梗死患者急诊介入后血清趋化素和白细胞介素37的影响[J].中华老年心脑血管病杂志,2018,(20)4:378-381.
[8]中华医学会心血管病学分会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):675-690.
[9] Gensini GG,A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606-606.
[10]Topaz O.Comparison between thrombus removal devices:aspirations meet reality[J].Catheter Cardiovasc Interv,2011,78(1):20-22.
[11]李宏松,许向东,吴国林,等.ST段抬高型心肌梗死患者急诊PCI术中选择性使用血栓抽吸策略的研究[J].临床心血管病杂志,2017,33(10):946-949.
[12]Chen J,Cui L,Yuan J,et al.Protective effect of diminazene attenuates myocardial infarction in rats via increased inflammation and ACE2activity[J].Mol Med Rep,2017,16(4):4791-4796.
[13]Ray KK,Cannon CP.The potential relevance of the multiple lipid-independent(pleiotropic)effects of statins in the management of acute coronary syndromes[J].J Am Coll Cardiol,2005,46(8):1425-1433.
[14]Wan Q,Cui X,Shao J,et al.Beijing ambient particle exposure accelerates atherosclerosis in ApoE knockout mice by upregulating visfatin expression[J].Cell Stress Chaperones,2014,19(5):715-724.
[15] Huang CL,Wu YW,Wu CC,et al.Association between serum adipocyte fatty-acid binding protein concentrations,left ventricular function and myocardial perfusion abnormalities in patients with coronary artery disease[J].Cardiovasc Diabetol,2013,12:105.
[16]金鑫,韩朝鑫,王彦富,等.趋化因子CCL21及其受体CCR7与冠状动脉易损斑块的相关性研究[J].临床心血管病杂志,2015,31,(12):1293-1296.
[17]Trepels T,Zeiher AM,Fichtlscherer S,et al.Acute coronary syndrome and inflammation.Biomarkers for diagnostics and risk stratification[J].Herz,2004,29(8):769-776.
[18]Niccoli G,Menozzi A,Capodanno D,et al.Relationship betweenseruminflammatorybiomarkersand thrombus characteristics in patients with ST segment elevation myocardial infarction[J].Cardiology,2017,137(1):27-35.
[19]Inci S,Aksan G,Do?an P.Chemerin as an independent predictor of cardiovascular event risk[J].Ther Adv Endocrinol Metab,2016,7(2):57-68.
[20]熊玮,董少红,张键,等.趋化素促进小鼠血管平滑肌细胞增殖的实验研究[J].临床心血管病杂志,2016,32(1):66-69.