急性心肌梗死患者冠脉介入治疗后血浆apelin的变化及作用

目的：观察急性心肌梗死（AMI）患者围手术期血浆apelin的表达变化，分析AMI合并2型糖尿病（T2DM）患者血浆apelin的表达与预后的相关性，探讨apelin在冠脉介入治疗（PCI）中的心脏保护作用。方法：72例于2012年2月-8月在我院心内科接受冠状动脉造影确诊为AMI并成功完成PCI的冠心病患者，分别在术前、术后0小时、术后4小时、术后24小时收集血清，酶联免疫吸附法测定血浆apelin-13水平；进一步对糖尿病及非糖尿病AMI患者（每组各20例）进行亚组分析，随访两组患者在术后6个月时主要不良心脑血管事件（MACCE）。结果：AMI患者术后0h组apelin水平与术前基线水平明显降低（31．54±5．48VS35．15±6．48ng／L，P〈0．05）；术后4小时及24小时组apelin水平较术前明显升高（39．65±5．48VS35．15±6．48ng／L，43．93±5．37VS35．15±6．48ng／L，P〈0．05）。糖尿病与非糖尿病组apelin水平术前无明显差异；糖尿病组在术后各时间点的apelin水平均明显高于非糖尿病组（31．12±5．50VS29．21±6．53ng／L，40．57＋5．37VS33．49±3．89ng／L，43．50±7．41VS34．54±3．52ng／L，P〈0．05）。两组术后6个月随访T2DM组LVEF值改善明显高于NT2DM组，但MACCE事件无明显差异。结论：AMI患者PCI术后存在血浆apelin表达的升高，其中糖尿病患者在术后血浆apelin表达较非糖尿病患者明显增高，提示PCI冠脉血运重建可促进糖尿病患者apelin分泌，调节胰岛素抵抗改善预后。

The Effect of Percutaneous Coronary Intervention on Plasma Apelin in Patients with Acute Myocardial Infarction＊

Objective： To evaluate the cardiac protection of perioperative plasma apelin of patients with acute myocardial infarction （AMI） in percutaneous coronary intervention （PCI）, and the relationship between apelin and patients with AMI complicated with type 2 diabetes （T2DM）. Methods： 72 patients with coronary heart disease diagnosed as AMI by coronary arteriography in the department of Cardiology in our hospital had completed PCI. Serum was collected before surgery and 0, 4, and 24 hours after surgery for ELISA to determine plasma apelin-13. A subgroup analysis was further performed on diabetes and non-diabetes AMI patients （20 cases for each group）, and the two groups of patients were followed 6 months post-PCI for main adverse cardiovascular and cerebrovascular events （MACCE）. Results： Apelin was significantly decreased in the postoperative Oh group （AM! patients） compared with that at baseline preoperatively; and significantly increased in the postoperative 4h and 24h groups compared with that before the PCI.No significantly difference was noted in apelin between DM and non-DM groups; postoperatively, apelin level was significantly higher in DM group compared with that in non-DM group. No significantly difference was noted with respect to MACCE between both groups in the postoperative month-6 follow-up. Conclusion： AMI patients had increased plasma apelin expression after PCI, of whom DM patients had significant increased plasma apelin expression after PCI compared with that of non-DM patients, indicating that PCI coronary revascularization may promote apelin secretion, and regulate insulin resistance, so as to improve prognosis.