急性冠脉综合征患者血清磷脂转运蛋白活性与N末端脑钠肽前体水平的相关性及预后意义
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摘要
目的:分析急性冠脉综合征(ACS)患者血清磷脂转运蛋白(PLTP)活性与N末端脑钠肽前体(NT-proBNP)水平的相关性及预后意义。方法:2014年至2016年期间,无锡市锡山人民医院心血管内科顺序入选ACS患者121例,测定PLTP活性和NT-proBNP水平、行心脏彩超及常规实验室检验,随访一年。结果:高NT-proBNP水平患者PLTP活性明显高于低NT-proBNP水平患者,多重线性回归提示NT-proBNP水平与PLTP活性相关(Beta=0.214,P=0.014)。左室收缩功能降低患者PLTP活性与NT-proBNP水平明显增高。Logistic回归分析提示高PLTP活性(OR=1.024,P=0.000)与高NT-proBNP水平(OR=1.000,P=0.027)是不良心脏事件的独立预测因子。ROC曲线显示高PLTP活性与高NT-proBNP水平预测不良心脏事件发生的曲线下面积分别为0.798与0.757。结论:ACS患者血清PLTP活性与NT-proBNP水平相关且能预测不良心脏事件的发生。
Objective: To investigate the association between serum phospholipid transfer protein(PLTP) activity and N-terminal pro brain natriuretic peptide(NT-proBNP) levels and whether these biomarkers could predict adverse cardiac events at 12-month follow-up in patients with acute coronary syndrome(ACS). Methods: A total of 121 ACS patients were recruited in the Xishan People's Hospital of Wuxi from June 2014 to June 2016, PLTP activity and NT-proBNP levels were measured. Patients were followed-up for one year, and information on adverse cardiac events was collected. Results: PLTP activity levels were significantly higher in patients with high NT-proBNP levels than that in patients with low NT-proBNP levels. Multiple linear regression analysis showed that high NT-proBNP levels were associated with PLTP activity(Beta=0.214, P=0.014). Patients with left ventricular systolic dysfunction had high PLTP activity and NT-proBNP levels. Logistic regression analysis revealed that increased PLTP activity(OR=1.024, P=0.000) and NT-proBNP levels(OR=1.000, P=0.027) independently predicted adverse cardiac events. The area under the curve of high PLTP activity and high NT-proBNP level in predicting adverse cardiac events were 0.798 and 0.757, respectively. Conclusion: Serum PLTP activity was associated with NT-proBNP levels, and they further reflected the adverse cardiac events in the ACS patients.
Objective: To investigate the association between serum phospholipid transfer protein(PLTP) activity and N-terminal pro brain natriuretic peptide(NT-proBNP) levels and whether these biomarkers could predict adverse cardiac events at 12-month follow-up in patients with acute coronary syndrome(ACS). Methods: A total of 121 ACS patients were recruited in the Xishan People's Hospital of Wuxi from June 2014 to June 2016, PLTP activity and NT-proBNP levels were measured. Patients were followed-up for one year, and information on adverse cardiac events was collected. Results: PLTP activity levels were significantly higher in patients with high NT-proBNP levels than that in patients with low NT-proBNP levels. Multiple linear regression analysis showed that high NT-proBNP levels were associated with PLTP activity(Beta=0.214, P=0.014). Patients with left ventricular systolic dysfunction had high PLTP activity and NT-proBNP levels. Logistic regression analysis revealed that increased PLTP activity(OR=1.024, P=0.000) and NT-proBNP levels(OR=1.000, P=0.027) independently predicted adverse cardiac events. The area under the curve of high PLTP activity and high NT-proBNP level in predicting adverse cardiac events were 0.798 and 0.757, respectively. Conclusion: Serum PLTP activity was associated with NT-proBNP levels, and they further reflected the adverse cardiac events in the ACS patients.
引文
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[16] GAGGIN H K,JANUZZI J L.Natriuretic peptides in heart failure and acute coronary syndrome[J].Clin Lab Med,2014,34(1):43- 58.
[17] SAMYN H,MOERLAND M,GENT T V,et al.,Elevation of systemic PLTP,but not macrophage- PLTP,impairs macrophage reverse cholesterol transport in transgenic mice[J].Atherosclerosis,2009,204(2):429- 434.
[18] YANG X,YU Y,WANG D,et al.Overexpressed PLTP in macrophage may promote cholesterol accumulation by prolonged endoplasmic reticulum stress[J].Med Hypotheses,2017,98(37):45- 48.
[19] ZHANG K,LIU X,YU Y,et al.Phospholipid transfer protein destabilizes mouse atherosclerotic plaque[J].Arterioscler Thromb Vasc Biol,2014,34(12):2537- 2544.
[20] CAVUSOGLU E,MARMUR J D,CHHABRA S,et al.Elevated baseline plasma phospholipid protein (PLTP) levels are an independent predictor of long- term all- cause mortality in patients with diabetes mellitus and known or suspected coronary artery disease[J].Atherosclerosis,2015,239(2):503- 508.
[21] AXEL S,STEFAN B,CHRISTOPH B,et al.PLTP activity is a risk factor for subsequent cardiovascular events in CAD patients under statin therapy:the atherogene study[J].J Lipid Res,2009,50(4):723- 729.
[2] YAZDANYAR A,QUAN W,JIANG X C.Liver- specific phospholipid transfer protein deficiency reduces high- density lipoprotein and non- high- density lipoprotein production in mice[J].Arterioscler Thromb Vasc Biol,2013,33(9):2058- 2064.
[3] VIKSTEDT R,YE D,METSO J,et al.Macrophage phospholipid transfer protein contributes significantly to total plasma phospholipid transfer activity and its deficiency leads to diminished atherosclerotic lesion development[J].Arterioscler Thromb Vasc Biol,2007,27(3):578- 586.
[4] TOL V,ARIE.Phospholipid transfer protein[J].Curr Opin Lipidol,2002,13(2):135- 139.
[5] YU Y,CUI Y,ZHAO Y,et al.The binding capability of plasma phospholipid transfer protein,but not HDL pool size,is critical to repress LPS induced inflammation[J].Sci Rep,2016,6:20845.
[6] ZHOU T,HE Q,TONG Y,et al.Phospholipid transfer protein (PLTP) deficiency impaired blood- brain barrier integrity by increasing cerebrovascular oxidative stress[J].Biochem Biophys Res Commun,2014,445(2):352- 356.
[7] CHEN X,SUN A,ZOU Y,et al.High PLTP activity is associated with depressed left ventricular systolic function[J].Atherosclerosis,2013,228(2):438- 442.
[8] CAVUSOGLU E,JDCHHABRA M.Relation of baseline plasma phospholipid transfer protein (PLTP) activity to left ventricular systolic dysfunction in patients referred for coronary angiography[J].Atherosclerosis,2009,207(1):261- 265.
[9] KLINGENBERG R,AGHLMANDI S,R?BER,L,et al.Improved risk stratification of patients with acute coronary syndromes using a combination of hsTnT,NT- proBNP and hsCRP with the GRACE score[J].Eur Heart J Acute Cardiovasc Care,2018,7(2):2048872616684678.
[10] SINNING C,OJEDA F,ZELLER T,et al.,Cardiovascular mortality in chest pain patients:comparison of natriuretic peptides with novel biomarkers of cardiovascular stress[J].Can J Cardiol,2016.32(12):1470- 1477.
[11] LONG A,LONG B,KOYFMAN A.Non- traditional risk factors for atherosclerotic disease:A review for emergency physicians[J].Am J Emerg Med,2018,36(3):494- 497.
[12] GIAMPAOLO N,SIMONA G,LUCA D V,et al.Severity of coronary atherosclerosis in patients with a first acute coronary event:a diabetes paradox[J].Eur Heart J,2013,34(10):729- 741.
[13] AHMED M H,AWADALLA H,ELMADHOUN W M,et al.Prevalence and risk factors for acute coronary syndrome among sudanese individuals with diabetes:A population- based study[J].Cardiol Res,2017,8(5):184- 189.
[14] CREA F,LIBBY P.Acute coronary syndromes:The way forward from mechanisms to precision treatment[J].Circulation,2017,136(12):1155- 1166.
[15] KINGERY J R,HAMID T,LEWIS R K,et al.Leukocyte iNOS is required for inflammation and pathological remodeling in ischemic heart failure[J].2017.112(2):19.
[16] GAGGIN H K,JANUZZI J L.Natriuretic peptides in heart failure and acute coronary syndrome[J].Clin Lab Med,2014,34(1):43- 58.
[17] SAMYN H,MOERLAND M,GENT T V,et al.,Elevation of systemic PLTP,but not macrophage- PLTP,impairs macrophage reverse cholesterol transport in transgenic mice[J].Atherosclerosis,2009,204(2):429- 434.
[18] YANG X,YU Y,WANG D,et al.Overexpressed PLTP in macrophage may promote cholesterol accumulation by prolonged endoplasmic reticulum stress[J].Med Hypotheses,2017,98(37):45- 48.
[19] ZHANG K,LIU X,YU Y,et al.Phospholipid transfer protein destabilizes mouse atherosclerotic plaque[J].Arterioscler Thromb Vasc Biol,2014,34(12):2537- 2544.
[20] CAVUSOGLU E,MARMUR J D,CHHABRA S,et al.Elevated baseline plasma phospholipid protein (PLTP) levels are an independent predictor of long- term all- cause mortality in patients with diabetes mellitus and known or suspected coronary artery disease[J].Atherosclerosis,2015,239(2):503- 508.
[21] AXEL S,STEFAN B,CHRISTOPH B,et al.PLTP activity is a risk factor for subsequent cardiovascular events in CAD patients under statin therapy:the atherogene study[J].J Lipid Res,2009,50(4):723- 729.