急性冠脉综合征患者外周血中抗α1-肾上腺素受体自身抗体表达的研究

发布时间：2018-03-27 06:17

本文选题：急性冠脉综合征　切入点：动脉粥样硬化　出处：《大连医科大学》2017年硕士论文

【摘要】：目的:检测抗α1肾上腺素受体自身抗体(Autoantibodies againstα1 adrenegic receptors,α1 AA)在急性冠脉综合征(Acute Coronary Syndrome,ACS)患者及正常人外周血中的表达,并比较冠心病与正常受试者之间、不同严重程度冠心病患者之间的差别,探讨α1 AA在冠心病患者中可能存在的作用。方法:分别收集在大连医科大学附属第二医院心内科病房住院经冠脉CTA或冠脉造影(CAG)明确冠脉无严重狭窄(狭窄50%管腔直径)的15名受试者为对照(Control)组,选取原发性高血压患者14例为高血压(HTN)组,不稳定性心绞痛(UA)组18例,不稳定性心绞痛合并高血压(HTN+UA)组22例,急性心肌梗死(21例),急性心肌梗死合并高血压(HTN+AMI)组14例;其中针对急性心肌梗死患者,以发病6小时、12小时、24小时、48小时、72小时、1周为时间点采集患者肘正中静脉血,其他受试者均采集清晨空腹静脉血,并分离得到血浆,用酶联免疫吸附试验(ELISA)检测血浆中α1 AA的水平,比较各分组之间的差异,并分析它在急性心肌梗死患者血浆中不同时间点的表达情况;分析α1 AA与GRACE评分、SYNTAX评分及冠心病相关临床检验指标的关系,多个样本均数组间比较采用one way ANOVA,双变量服从正态分布进行Pearson相关分析,危险因素分析采用多因素Logistic回归分析。结果:1.正常对照组中亦有α1 AA表达,但水平较低;2.高血压组患者的血清中α1 AA水平较正常对照组高,具有统计学意义;3.同正常对照组比较,不稳定性心绞痛组未见明显差异,急性心肌梗死组α1 AA水平明显降低,P0.05;4.同高血压组相比,不稳定性心绞痛合并高血压组未见差异,急性心肌梗死合并高血压组的α1 AA表达明显降低,P0.05;5.不稳定性心绞痛组较急性心肌梗死组血清中α1 AA表达明显高,P0.05;;不稳定性心绞痛合并高血压组较心肌梗死合并高血压组的α1 AA水平明显高,P0.05;6.合并高血压的不稳定性心绞痛组较不合并高血压一组表达更高,P0.05;合并高血压的急性心肌梗死组较不合并高血压一组表达增高,但不存在明显差异,P0.05;7.急性心肌梗死发病起始的12h、72h以及1w时血清中α1 AA水平较6h减低,12h、72h以及1w的水平不存在显著差异,P0.05;8.ACS患者的α1 AA表达水平同GRACE评分相关分析显示二者呈负性相关(R= 0.516,P0.01)。9.急性心肌梗死患者的α1 AA的回归系数是0.038,P0.01,95.0%置信区间是1.017 1.061;白细胞数(WBC)的回归系数是 0.587,P0.01,95.0%置信区间是0.392 0.788。结论:α1 AA在急性心肌梗死患者血清中表达减低,且同疾病严重程度呈负性相关。
[Abstract]:Objective: to detect the expression of autoantibodies against 伪 1-adrenoceptor against 伪 1 adrenegic receptors (伪 1-AAA) in peripheral blood of patients with acute Coronary syndromes and normal controls, and to compare the expression between coronary heart disease and normal subjects. Differences between patients with different severity of coronary heart disease, To explore the possible role of 伪 1 / AA in coronary heart disease (CHD). Methods: 50% coronary artery stenosis (50% stenosis) was confirmed by CTA or CAG in the cardiology ward of the second affiliated Hospital of Dalian Medical University. The control group consisted of 15 subjects with cavity diameter. Fourteen patients with essential hypertension were selected as essential hypertension group, 18 patients with unstable angina pectoris (UAA), 22 patients with unstable angina pectoris with hypertension (HTN UAA), 21 patients with acute myocardial infarction (AMI) and 14 patients with acute myocardial infarction (AMI). For the patients with acute myocardial infarction, the median elbow vein blood was collected at the point of 6 hours, 12 hours, 24 hours and 48 hours and 72 hours and 1 week. The other subjects collected fasting venous blood in the morning and separated the plasma. Elisa was used to detect the level of 伪 _ 1 AA in plasma, to compare the difference among different groups, and to analyze its expression at different time points in patients with acute myocardial infarction (AMI). To analyze the relationship between 伪 1 AA and GRACE score and clinical test indexes related to coronary heart disease, one way ANOVA was used for comparison among the multiple sample mean groups, and the Pearson correlation analysis was carried out from normal distribution. Multivariate Logistic regression analysis was used to analyze the risk factors. Results: 1. The expression of 伪 1 AA was also found in the normal control group, but the level was lower than that in the normal control group. The serum level of 伪 1 AA in the hypertension group was higher than that in the normal control group. There was no significant difference between unstable angina pectoris group and normal control group, but the level of 伪 1 and AA in acute myocardial infarction group was significantly lower than that in hypertension group. There was no significant difference between unstable angina pectoris group and hypertension group. The expression of 伪 _ 1 伪 _ 1 in patients with acute myocardial infarction and hypertension was significantly lower than that in patients with unstable angina pectoris than that in patients with acute myocardial infarction (AMI), and the expression of 伪 _ 1 伪 _ 1 in patients with unstable angina pectoris with hypertension was significantly higher than that in patients with unstable angina pectoris complicated with hypertension. The level of 伪 _ 1 伪 _ 1 in blood pressure group was significantly higher than that in hypertension group (P 0.05). The expression of 伪 _ 1 AA in unstable angina pectoris group with hypertension was higher than that in non-hypertension group, and the expression of 伪 _ 1 AA in acute myocardial infarction group with hypertension was higher than that in non-hypertension group. However, there was no significant difference between P0.05 and 77.The level of 伪 _ 1 AA in the serum of patients with acute myocardial infarction at the onset of acute myocardial infarction at 12h, 72h and 1w was significantly lower than that at 6h, 12h, 72h and 1w respectively. There was no significant difference in the expression of 伪 _ 1 伪 _ 1 in patients with acute myocardial infarction at 12h, 72h and 1w. The correlation analysis between 伪 _ 1-AA expression and GRACE score in patients with acute myocardial infarction showed that. There was a negative correlation between the two. The regression coefficient of 伪 _ 1AA was 0.038 渭 P _ (0.01) ~ 95.0% confidence interval was 1.017 ~ 1.061, the regression coefficient of white blood cell count was 1.017 ~ 1.061, and the regression coefficient of WBC was 0.392 0.788. Conclusion: the expression of 伪 _ 1AA in the serum of patients with acute myocardial infarction is lower than that of WBC _ (0.587g) P0.01P _ (0.95)% confidence interval is 0.392 0.788.Conclusion: the expression of 伪 _ (1) AA in serum of patients with acute myocardial infarction is lower than that of patients with acute myocardial infarction. There was a negative correlation with the severity of the disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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