急性心梗患者PCI术中并发心室纤颤的影响因素及Gensini评分、血钾对其预测价值

摘要 目的：探讨分析AMI患者PCI术中并发VF的影响因素以及冠脉Gensini评分、血钾对其预测价值。方法：从2016年6月至2019年6月于我院就诊的AMI患者中筛选出356例,对其临床资料进行回顾性分析。以AMI患者PCI术中是否并发VF为依据进行组别划分,分为VF组（49组）、NVF组（未并发VF,307例）。整理比较两组一般资料、临床资料,并对两组患者冠脉造影特征、冠脉Gensini评分作对比分析,对AMI患者PCI术中并发VF的可疑性影响因素行多因素Logistic回顾分析,以确定其危险因素,并对危险因素行ROC曲线分析以确定其预测价值。结果：VF组和NVF组在性别、年龄、吸烟史、饮酒史、高血压史、糖尿病史、既往应用β受体阻滞剂及阿司匹林,入院时收缩压和心率方面,均无统计学差别（P>0.05）,临床血指标检测上,VF组血钾水平明显低于NVF组,差异具有统计学意义（P<0.05）,冠脉造影检查显示VF组TIMI血流0级、Gensini积分高及血栓负荷重例数高于NVF组,差异具有统计学意义（P<0.05）。多因素Logistic回归分析显示TIMI血流分级0级、血钾、Gensini评分为AMI患者PCI术中并发VF的独立危险因素（P<0.05）。ROC曲线分析结果显示,TIMI血流分级0级、血钾、Gensini评分均对AMI患者PCI术中并发VF具有一定的预测价值,其ROC曲线下面积分别为0.619、0.816、0.842（P值均＜0.05）,提示血钾、Gensini评分具有中等预测价值,TIMI血流分级0级预测价值较低。当血钾、Gensini评分分别处4.05、89.95最佳截断值时,其敏感度分别为100%、63.3%,特异度分别为为41.8%、94.1%。结论：TIMI血流分级0级、血钾、Gensini评分为AMI患者PCI术中并发VF的独立危险因素。TIMI血流分级0级、血钾、Gensini评分均对AMI患者PCI术中并发VF具有一定的预测价值。血钾、Gensini评分具中等预测价值,TIMI血流分级0级预测价值较低。     

血清UA、sdLDL、sST2对急性心肌梗死患者PCI术后无复流的预测价值分析

摘要 目的：探讨血清尿酸（UA）、小而密低密度脂蛋白（sdLDL）、可溶性致癌抑制因子2（sST2）对急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）术后无复流（NRF）的预测价值。方法：选取2021年1月～2023年1月睢宁县人民医院收治的196例AMI患者为AMI组，根据PCI术后是否发生NRF分为NRF组和血流正常组，另选取同期120名体检健康志愿者为对照组。比较AMI组与对照组血清UA、sdLDL、sST2水平。采用多因素Logistic回归分析AMI患者PCI术后NRF的影响因素，采用受试者工作特征（ROC）曲线分析血清UA、sdLDL、sST2水平对AMI患者PCI术后NRF的预测价值。结果：与对照组比较，AMI组血清UA、sdLDL、sST2水平升高（P＜0.05）。196例AMI患者PCI术后NRF发生率为34.69%，NRF组年龄大于血流正常组，糖尿病比例、肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）、低密度脂蛋白胆固醇（LDL-C）、UA、sdLDL、sST2水平高于血流正常组（P＜0.05）。多因素Logistic回归分析显示，年龄增加和UA、sdLDL、sST2升高为AMI患者PCI术后NRF的独立危险因素（P＜0.05）。ROC曲线分析显示，血清UA、sdLDL、sST2水平单独和联合预测AMI患者PCI术后NRF的曲线下面积AUC(0.95CI)分别为0.707(0.481～0.934)、0.742(0.513～0.955)、0.737(0.480～0.970)、0.863(0.737～0.960)，联合预测大于单独预测指标。结论：血清UA、sdLDL、sST2水平升高为AMI患者PCI术后NRF的独立危险因素，血清UA、sdLDL、sST2水平联合预测AMI患者PCI术后NRF的价值较高。     

Plasma levels of soluble ST2, but not IL‐33, correlate with the severity of alcoholic liver disease

Alcoholic liver disease (ALD) is a complication that is a burden on global health and economy. Interleukin‐33 (IL‐33) is a newly identified member of the IL‐1 cytokine family and is released as an “alarmin” during inflammation. Soluble suppression of tumourigenicity 2 (sST2), an IL‐33 decoy receptor, has been reported as a new biomarker for the severity of systemic and highly inflammatory diseases. Here, we found the levels of plasma sST2, increased with the disease severity from mild to severe ALD. Importantly, the plasma sST2 levels in ALD patients not only correlated with scores for prognostic models (Maddrey's discriminant function, model for end‐stage liver disease and Child‐Pugh scores) and indexes for liver function (total bilirubin, international normalized ratio, albumin, and cholinesterase) but also correlated with neutrophil‐associated factors as well as some proinflammatory cytokines. In vitro, lipopolysaccharide‐activated monocytes down‐regulated transmembrane ST2 receptor but up‐regulated sST2 mRNA and protein expression and produced higher levels of tumour necrosis factor‐α (TNF‐α). By contrast, monocytes pretreated with recombinant sST2 showed decreased TNF‐α production. In addition, although plasma IL‐33 levels were comparable between healthy controls and ALD patients, we found the IL‐33 expression in liver tissues from ALD patients was down‐regulated at both RNA and protein levels. Immunohistochemical staining further showed that the decreased of IL‐33‐positive cells were mainly located in liver lobule area. These results suggested that sST2, but not IL‐33, is closely related to the severity of ALD. Consequently, sST2 could be used as a potential biomarker for predicting the prognosis of ALD.     

血清脑钠肽、超敏C反应蛋白、可溶性ST2对阵发性心房颤动患者射频消融术后复发的预测价值研究

摘要 目的：探讨血清脑钠肽（BNP）、超敏C反应蛋白（hs-CRP）、可溶性致瘤抑制素2（sST2）对阵发性心房颤动（AF）患者射频消融（RFA）术后复发的预测价值。方法：选择2016年1月至2020年12月我院收治的接受RFA术治疗的82例阵发性AF患者,术后随访12个月,根据术后是否复发分为复发组（25例）和未复发组（57例）。检测患者血清BNP、hs-CRP、sST2水平,收集临床相关资料,采用多因素Logistic回归模型分析影响阵发性AF患者RFA术后复发的因素,采用受试者工作特征（ROC）曲线分析血清BNP、hs-CRP、sST2预测阵发性AF患者RFA术后复发的价值。结果：复发组血清BNP、hs-CRP、sST2水平高于未复发组（P＜0.05）。血清BNP、hs-CRP、sST2水平升高、AF病程增长是影响阵发性AF患者RFA术后复发的危险因素（P＜0.05）。血清BNP、hs-CRP、sST2预测阵发性AF患者消融术后复发的曲线下面积分别为0.720、0.694、0.718,联合三者预测阵发性AF患者RFA术后复发的曲线下面积为0.866,高于BNP、hs-CRP、sST2单独预测。结论：阵发性AF患者血清BNP、hs-CRP、sST2水平升高是RFA术后复发的危险因素,联合检测血清BNP、hs-CRP、sST2水平有助于预测阵发性AF患者RFA术后复发。     

C - 反应蛋白在不同程度急性心梗患者中的相关性研究

目的:探讨C-反应蛋白(CRP)在急性心肌梗死患者中的变化及与心功能之间的关系。方法:选取121例急性心肌梗死(AMI)患者和50例健康对照者,酶联免疫吸附法(ELISA)检测血清C-反应蛋白(CRP)和B型钠尿肽(BNP)。结果:AMI患者血清CRP显著高于健康对照,AMI伴心功能III,IV级者血清BNP、CRP显著高于AMI伴心功能I,II级者。结论:血清CRP对于急性心肌梗死患者的心功能重要参考指标。     

Serum CD121a (Interleukin 1 Receptor,Type I): A Potential Novel Inflammatory Marker for Coronary Heart Disease

Inflammation is now believed to be responsible for coronary heart disease (CHD). This belief has stimulated the evaluation of various inflammatory markers for predicting CHD. This study was designed to investigate the association between four inflammatory cytokines (CD121a, interleukin [IL]-1β, IL-8, and IL-11) and CHD. Here, we evaluated 443 patients with CHD and 160 CHD-free controls who underwent coronary angiography. Cytokines were evaluated using flow cytometry, and statistical analyses were performed to investigate the association between cytokine levels and the risk of CHD. Patients with CHD had significantly higher levels of CD121a. The odds ratios for CHD according to increasing CD121a quartiles were 1.00, 1.47 [95% confidence interval (CI): 0.79–2.72], 2.67 (95% CI: 1.47–4.84), and 4.71 (95% CI: 2.65–8.37) in an age- and sex-adjusted model, compared to 1.00, 1.48 (95% CI: 0.70–3.14), 2.25 (95% CI: 1.10–4.62), and 4.39 (95% CI: 2.19–8.79) in a model that was adjusted for multiple covariates. A comparison of the stable angina, unstable angina, and acute myocardial infarction (AMI) subgroups revealed that patients with AMI had the highest CD121a levels, although IL-1β levels were similar across all groups. IL-8 levels were also increased in AMI patients, and IL-11 levels were higher in CHD patients than in non-CHD patients. Correlation analysis revealed a positive association between CD121a, IL-8, and the Gensini score. Together, the significant increase in CD121a levels among CHD patients suggests that it may be a novel inflammatory marker for predicting CHD.     

Haptoglobin genotype predicts development of coronary artery calcification in a prospective cohort of patients with type 1 diabetes

Background

Soluble ST2, a member of the of the Toll/IL-1 superfamily, is a novel biomarker with exceptional predictive value in heart failure and myocardial infarction- related mortality as well as in acute dyspneic states. Soluble ST2 is considered a decoy receptor of IL 33 that blocks the protective effects of the cytokine in atherosclerosis and cardiac remodeling. In the present study we investigated the differences in the levels of soluble ST2, BNP and hs-CRP between healthy controls and patients with type 2 diabetes with and without left ventricular diastolic dysfunction. A secondary aim was to investigate correlations between sST2 and other biomarkers of type 2 diabetes, such as HbA1c.

Methods

158 volunteers were recruited and underwent a complete Doppler-echocardiographic evaluation of both systolic & diastolic cardiac function. All subjects with ejection fraction < 50% were excluded. The study population was divided in 4 groups as follows: A: 42 healthy controls, B: 18 subjects without diabetes with LVDD, C: 48 patients with type 2 diabetes without LVDD & D: 50 patients with type 2 diabetes & LVDD. ELISA technique was performed to measure sST2 levels. Statistical analysis was performed with Kruskal-Wallis & Mann-Whitney test (continuous variables), chi squared & Fischer exact test (discrete variables), Spearman coefficient (univariate analysis) and step-wise backward method (multivariate analysis).

Results

Patients with type 2 diabetes with (p < 0.001) or without LVDD (p = 0.007) had higher serum ST2 levels compared to healthy controls, state found also for hs-CRP levels but not for the corresponding BNP levels (p = 0.213 & p = 0.207 respectively). Patients with type 2 diabetes & LVDD had higher serum ST2 in relation to diabetic patients without LVDD (p = 0.001). In multivariate analysis HbA1c positively and independently correlated with sST2 levels in both groups of patients with type 2 diabetes.

Conclusions

Patients with type 2 diabetes exhibit higher sST2 levels compared to healthy controls. The presence of LVDD in patients with type 2 diabetes is associated with even higher sST2 levels. A significant correlation between glycemic control and sST2 levels was also revealed.     

B-type natriuretic peptide predicts new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

The predictive value of B-type natriuretic peptide (BNP) with respect to the occurrence of new-onset atrial fibrillation (AF) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) is unknown. The aim of this study was to evaluate whether BNP has a predictive value for the occurrence of new-onset AF in patients with STEMI treated by primary PCI. In 180 patients with STEMI treated by primary PCI, BNP concentrations were measured 24h after chest pain onset. The Receiver Operating Characteristic analysis was performed to identify the most useful BNP cut-off level for the prediction of AF. The patients were divided into the two groups according to calculated cut-off level: high BNP group (BNP≥720 pg/mL, n=33) and low BNP group (BNP<720 pg/mL, n=147). The incidence of AF was 5.0%, and occurred more frequently in high BNP group (7/33, 21.2%) than in low BNP group (2/147, 1.4%), (p<0.001). Patients with high BNP were older (p=0.017), had more often anterior wall infarction (p=0.015), higher Killip class on admission (p=0.038), higher peak troponin I (p=0.002), lower left ventricular ejection fraction (p=0.029) than patients with low BNP. After multivariate adjustment, BNP was an independent predictor of AF (OR 3.70, 95% CI 1.40-9.77, p=0.008). BNP independently predicts the occurrence of new-onset AF in STEMI patients treated by primary PCI.     

C-反应蛋白在不同程度急性心梗患者中的相关性研究

目的：探讨C-反应蛋白（CRP）在急性心肌梗死患者中的变化及与心功能之间的关系。方法：选取121例急性心肌梗死（AMI）患者和50例健康对照者,酶联免疫吸附法（ELISA）检测血清C-反应蛋白（CRP）和B型钠尿肽（BNP）。结果：AMI患者血清CRP显著高于健康对照,AMI伴心功能III,IV级者血清BNP、CRP显著高于AMI伴心功能I,II级者。结论：血清CRP对于急性心肌梗死患者的心功能重要参考指标。     

Combined Biomarker Analysis for Risk of Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

Background

Acute kidney injury (AKI) complicating ST-segment elevation myocardial infarction (STEMI) increases subsequent morbidity and mortality. We combined the biomarkers of heart failure (HF; B-type natriuretic peptide [BNP] and soluble ST2 [sST2]) and renal injury (NGAL [neutrophil gelatinase-associated lipocalin] and cystatin C) in predicting the development of AKI in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods and Results

From March 2010 to September 2013, 189 STEMI patients were sequentially enrolled and serum samples were collected at presentation for BNP, sST2, NGAL and cystatin C analysis. 37 patients (19.6%) developed AKI of varying severity within 48 hours of presentation. Univariate analysis showed age, Killip class ≥2, hypertension, white blood cell counts, hemoglobin, estimated glomerular filtration rate, blood urea nitrogen, creatinine, and all the four biomarkers were predictive of AKI. Serum levels of the biomarkers were correlated with risk of AKI and the Acute Kidney Injury Network (AKIN) stage and all significantly discriminated AKI (area under the receiver operating characteristic [ROC] curve: BNP: 0.86, sST2: 0.74, NGAL: 0.75, cystatin C: 0.73; all P < 0.05). Elevation of ≥2 of the biomarkers higher than the cutoff values derived from the ROC analysis improved AKI risk stratification, regardless of the creatine level (creatinine < 1.24 mg/dL: odds ratio [OR] 11.25, 95% confidence interval [CI] 1.63-77.92, P = 0.014; creatinine ≥ 1.24: OR 15.0, 95% CI 1.23-183.6, P = 0.034).

Conclusions

In this study of STEMI patients undergoing primary PCI, the biomarkers of heart failure (BNP and sST2) and renal injury (NGAL and cystatin C) at presentation were predictive of AKI. High serum levels of the biomarkers were associated with an elevated risk and more advanced stage of AKI. Regardless of the creatinine level, elevation of ≥2 of the biomarkers higher than the cutoff values indicated a further rise in AKI risk. Combined biomarker approach may assist in risk stratification of AKI in patients with STEMI.     

Soluble ST2 and Interleukin-33 Levels in Coronary Artery Disease: Relation to Disease Activity and Adverse Outcome

Objectives

ST2 is a receptor for interleukin (IL)-33. We investigated an association of soluble ST2 (sST2) and IL-33 serum levels with different clinical stages of coronary artery disease. We assessed the predictive value of sST2 and IL-33 in patients with stable angina, non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI).

Methods

We included 373 patients of whom 178 had stable angina, 97 had NSTEMI, and 98 had STEMI. Patients were followed for a mean of 43 months. The control group consisted of 65 individuals without significant stenosis on coronary angiography. Serum levels of sST2 and IL-33 were measured by ELISAs.

Results

sST2 levels were significantly increased in patients with STEMI as compared to patients with NSTEMI and stable angina as well as with controls. IL-33 levels did not differ between the four groups. During follow-up, 37 (10%) patients died and the combined endpoint (all cause death, MI and rehospitalisation for cardiac causes) occurred in 66 (17.6%) patients. sST2 serum levels significantly predicted mortality in the total cohort. When patients were stratified according to their clinical presentation, the highest quintile of sST2 significantly predicted mortality in patients with STEMI, but not with NSTEMI or stable coronary artery disease. sST2 was a significant predictor for the combined endpoint in STEMI patients and in patients with stable angina. Serum levels of IL-33 were not associated with clinical outcome in the total cohort, but the highest quintile of IL-33 predicted mortality in patients with STEMI.

Conclusions

Serum levels of sST2 are increased in patients with acute coronary syndromes as compared to levels in patients with stable coronary artery disease and in individuals without coronary artery disease. sST2 and IL-33 were associated with mortality in patients with STEMI but not in patients with NSTEMI or stable angina.     

老年冠心病患者血清Lp-PLA2、hs-CRP、IL-27及MMP-9水平与Gensini积分的相关性研究*

目的:探讨老年冠心病患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、高敏C反应蛋白(hs-CRP)、白细胞介素-27(IL-27)及基质金属蛋白酶-9(MMP-9)水平与Gensini积分的相关性。方法:选取2015年10月至2018年2月我院收治的冠心病患者142例为研究对象,将所有患者按照不同的冠心病类型分为不稳定型心绞痛(UAP)组54例、稳定型心绞痛(SAP)组40例和急性心肌梗死(AMI)组48例。同时根据患者Gensini积分将其分为轻度47例、中度51例和重度44例。比较不同冠心病类型、不同严重程度的Lp-PLA2、hs-CRP、IL-27、MMP-9水平及Gensini积分,并分析冠心病患者上述指标水平与Gensini积分的相关性。结果:AMI组患者Lp-PLA2、hs-CRP、IL-27、MMP-9水平及Gensini积分均高于UAP组和SAP组,且UAP组高于SAP组(P0.05)。重度患者Lp-PLA2、hs-CRP、IL-27、MMP-9水平及Gensini积分均高于中度和轻度患者,且中度患者高于轻度患者(P0.05)。经Spearman相关性分析结果显示,冠心病患者Lp-PLA2、hs-CRP、IL-27、MMP-9水平与Gensini积分均呈正相关(P0.05)。结论:老年冠心病患者Lp-PLA2、hs-CRP、IL-27及MMP-9水平与患者冠状动脉病变Gensini积分均呈正相关。临床根据Lp-PLA2、hs-CRP、IL-27及MMP-9水平的变化,有助于评估老年冠心病患者的病情严重程度。     

Atrial natriuretic peptide, B-type natriuretic peptide, and serum collagen markers after acute myocardial infarction.

Experimental data suggest that atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) act locally as antifibrotic factors in heart. We investigated the interrelationships of natriuretic peptides and collagen markers in 93 patients receiving thrombolytic treatment for their first acute myocardial infarction (AMI). Collagen formation following AMI, evaluated as serum levels of amino terminal propeptide of type III procollagen, correlated with NH(2)-terminal proANP (r = 0.45, P < 0.001), BNP (r = 0.55, P < 0.001) and NH(2)-terminal proBNP (r = 0.50, P < 0.01) on day 4 after thrombolysis. Levels of intact amino terminal propeptide of type I procollagen decreased by 34% (P < 0.001), and levels of carboxy terminal cross-linked telopeptide of type I collagen (ICTP) increased by 65% (P < 0.001). ICTP levels correlated with NH(2)-terminal proBNP (r = 0.25, P < 0.05) and BNP (r = 0.28, P < 0.05) on day 4. Our results suggest that ANP and BNP may act as regulators of collagen scar formation and left ventricular remodeling after AMI in humans. Furthermore, degradation of type I collagen is increased after AMI and may be regulated by BNP.     

血清vaspin、IL-6水平对急性心肌梗死后左室重构的评估价值

目的:观察冠脉介入治疗的急性心肌梗死(AMI)患者的左室重构与血清脂肪特异性丝氨酸蛋白酶抑制剂(vaspin)和白介素-6(IL-6)水平的相关性。方法:入选的研究对象(50例)均来自于2018年9月～2019年6月就诊于同济大学附属普陀人民医院且被诊断为AMI的住院患者,患者均经早期经皮冠脉介入(PCI)治疗,术后规范药物治疗。采用酶联免疫吸附实验(ELISA)测定50例患者发病后1天、7天、30天的血清vaspin和IL-6水平并行超声心动图检查。同时以50例健康体健者作为对照组。比较两组间血清vaspin、IL-6水平的差异,观察AMI后血清vaspin、IL-6水平的变化趋势及其与左室重构的指标包括左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)的相关性。结果:(1)对照组血清vaspin水平为6.03±1.18 ng/mL,AMI组血清vaspin水平4.22±1.37 ng/mL,AMI组血清vaspin水平明显低于对照组(P0.05),且AMI后1月内血清vaspin水平逐渐降低(P0.05);对照组血清IL-6水平为12.04±3.97 ng/mL,AMI组血清IL-6水平为26.72±10.06 ng/mL,AMI组患者血清IL-6水平明显高于对照组(P0.05),且AMI后1月内血清IL-6水平逐渐升高(P0.05);(2)经相关性分析显示:AMI后1天、7天、30天血清vaspin水平与LVEDD、LVESD均呈负相关(P0.05),血清IL-6水平与LVEDD、LVESD均呈正相关(P0.05),血清vaspin水平与IL-6水平均呈负相关(P0.001)。结论:急性心肌梗死后早期,左室重构的进展伴随着血清vaspin的降低与IL-6的升高,临床上应监测两种指标的变化,对左室重构早期干预,预防心力衰竭的发生。     

冠状动脉粥样硬化性心脏病患者血清SFRP5、FGF21、IGF-I水平与血脂和冠状动脉病变严重程度的相关性研究

目的:探讨冠状动脉粥样硬化性心脏病(CHD)患者血清分泌型卷曲蛋白5(SFRP5)、成纤维细胞生长因子21(FGF21)、胰岛素样生长因子-1(IGF-I)水平与血脂和冠状动脉病变严重程度的相关性。方法:选择2018年6月至2021年6月我院收治的109例CHD患者(CHD组),根据冠心病类型分为稳定型心绞痛组(SAP组,32例),不稳定型心绞痛组(UA组,42例)、急性心肌梗死组(AMI组,35例),根据Gensini积分分为轻度病变组(≤20分,42例)、中度病变组(21~40分,44例)和重度病变组(>40分,23例),另选择同期在我院行冠脉造影检查结果为正常的53例患者为对照组。检测并比较各组血清SFRP5、FGF21、IGF-I、血脂水平,分析血清SFRP5、FGF21、IGF-I与血脂和Gensini积分的相关性。结果:不同类型、不同冠脉病变程度CHD患者的血清SFRP5、FGF21、IGF-I、HDL-C水平均低于对照组,血清TC、TG、LDL-C水平均高于对照组,差异有统计学意义(P<0.05);血清SFRP5、FGF21、IGF-I水平的差异比较中,UA组低于SAP组,AMI组又低于UA组,中度病变组低于轻度病变组,重度病变组又低于中度病变组,差异均有统计学意义(P<0.05);血清TC、LDL-C水平的差异比较中,UA组高于SAP组,AMI组又高于UA组,中度病变组高于轻度病变组,重度病变组又高于中度病变组,差异均有统计学意义(P<0.05);而SAP组、UA组、AMI组之间两两比较以及轻度病变组、中度病变组、重度病变组之间两两比较的血清TG、HDL-C水平差异无统计学意义(P>0.05)。Pearson相关性分析结果显示:血清SFRP5、FGF21、IGF-I水平与TC、LDL-C、Gensini积分呈负相关(P<0.05)。结论:CHD患者血清SFRP5、FGF21、IGF-I水平均降低,且与血脂水平增高以及CHD病变程度加重均有关。     

B型钠尿肽对急性心肌缺血损伤发挥保护作用的机制

本研究旨在研究B型钠尿肽(brain natriuretic peptide, BNP)对异丙肾上腺素(isoproterenol, ISO)诱导的急性心肌缺血(acute myocardial ischemia, AMI)相关损伤的保护作用。将大鼠随机分作5组:对照组、ISO处理组、ISO+普萘洛尔(5 mg/kg)处理组、ISO+BNP (5 mg/kg)和ISO+BNP (10 mg/kg)处理组。再将4个给药组中的大鼠连续2 d皮下注射ISO。通过心电图(ECG)记录ST段数据;ELISA检测血清中肌酸激酶(CK)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6 (IL-6)和IL-1β的表达水平;接着使用Western blotting对Bax-2、Bcl-2、PI3K、Akt、GSK-3β、MDA5和SOD1蛋白表达水平进行检测,并测定PI3K、Akt和GSK-3β的磷酸化。实验结果显示,BNP (5 mg/kg, 10 mg/kg)可降低血清中MDA和CK的表达水平以及SOD和LDH的蛋白活性;经BNP预处理显著降低了促炎因子IL-1β、IL-6和TNF-α的表达水平;同时BNP也降低了ST段抬高。此外,BNP改善了ISO诱导的大鼠中SOD1、MDA5、Bax-2、Bcl-2、p-PI3K、p-Akt和p-GSK-3β的表达。综上所述,通过调节PI3K/Akt/GSK-3β信号传导途径,BNP保护大鼠免受AMI损伤。     

急性心肌梗死患者脑钠肽水平与血管病变的关系

目的:探讨急性心肌梗死患者血浆脑钠肽(BNP)水平与梗死相关动脉及病变血管的关系。方法:选取2010.7-2011.7于上海市第一人民医院诊断为急性心肌梗死的患者。分为ST抬高型心梗患者和非ST抬高型心梗患者两组,比较BNP水平与血管病变的关系。结果:(1)两组患者的年龄、男女比例、高血压病与糖尿病患病率、吸烟患者比例之间无显著差异。NSTEMI患者中,既往心梗和既往经皮冠状动脉成形术(PTCA)的比例和左室射血分数明显高于STEMI患者。(2)NSTEMI患者多支血管病变比例显著高于STEMI患者并且梗死相关动脉为左回旋支(LCX)的比例显著高于STEMI患者。(3)病变血管支数与心梗患者BNP水平无关,STEMI患者左冠状动脉前降支(LAD)为IRA的患者BNP水平显著高于LCX和右冠状动脉(RCA)分别为IRA的患者。NSTEMI患者LAD、LCX和RCA分别为IRA的患者其BNP水平无显著差异。结论:STEMI患者前壁心梗BNP水平较高,NSTEMI患者BNP水平对血管病变支数和IRA无预测价值。     

血清IgE水平与冠心病的相关性分析

目的:探讨血清IgE水平与冠心病的相关性。方法:将我院收治的135例患者根据冠脉造影结果分为冠心病组(CHD)和非冠心病组(non-CHD),冠心病组根据临床症状分为稳定型心绞痛组(SAP)、不稳定型心绞痛组(UAP)和急性心肌梗死组(AMI),动脉堵塞程度用Gensini评分量化,采用SIMENS BNII全自动免疫散射比浊仪测定总IgE水平。比较CHD和non-CHD组患者及SAP、UAP和AMI组患者血清IgE水平的差异,并进一步分析血清IgE等级与冠心病Gensini积分的相关性。结果:non-CHD患者血清IgE水平(32.3(13.5,61)KU/L)明显低于CHD患者(69(26.4,169)KU/L)(P=0.001),UAP和AMI患者血清IgE水平(78.6(37.0,191.0)KU/L、118.5(75.3,148.1)KU/L)均显著高于SAP组(36.7(20.7,96.7)KU/L)(P=0.034和P=0.001),且多支血病变组患者血清IgE水平(67.2(30.9,249.0)KU/L)显著高于单支血管病变患者(34.6(18.1,59.0)KU/L)(P=0.039)。IgE水平根据四分位间距分为四个等级,随着IgE分级水平增加冠心病Gensini积分增加。结论:冠心病患者血清IgE水平升高,且与冠心病类型和血管堵塞程度都存在显著相关性,可能辅助冠心病的诊断及病情监测。