急性心肌梗死患者血清组织蛋白酶S水平与心力衰竭的相关性分析

发布时间：2018-05-04 22:07

本文选题：组织蛋白酶S + 急性心肌梗死　；参考：《浙江大学》2014年硕士论文

【摘要】：目的分析急性心肌梗死患者血清组织蛋白酶S (Cathepsin S, CatS)水平与心力衰竭之间的相关性,探讨血清CatS水平作为急性心肌梗死合并心力衰竭的生物标记物的诊断价值。方法纳入在2013年1月1日至2013年12月30日在浙江大学医学院附属第二医院心内科进行选择性冠状动脉造影的患者,根据临床表现、心电图、心肌酶谱及冠脉造影结果选取确诊为急性心肌梗死(包括ST段抬高心肌梗死及非ST段抬高心肌梗死)的患者147例,另选择明确无冠心病的患者107例及诊断为不稳定性心绞痛的患者107例作为对照,并根据入院后首次超声心动图测算的左室射血分数(ejection fraction, EF)将其分为心功能正常组及心力衰竭组。所有患者行冠脉造影前采集动脉血,用ELISA去测定血清CatS水平。应用SPSS200统计软件分析,P0.05作为有统计学意义。结果两组入选患者中,心功能正常组较心衰组有更多的老年患者(心功能正常组平均年龄64.92+12.02岁VS心力衰竭组61.22+12.60岁,P=0.03),其余各临床基线指标均无统计学差异。两组患者血清CatS水平中位数分别为6.68ng/ml(5.55-7.77ng/m1)与7.12ng/ml (5.42-8.49ng/ml),并未体现出统计学差异(P=0.7058)。校正年龄及性别后,连续性分析两组患者血清CatS水平与左室射血分数也不存在相关性(OR=1.05,95%置信区间0.93～1.12)。校正身高,体重、体重指数、性别、吸烟史、高血压病史、血脂异常疾病史、糖尿病史、外周血管疾病史、脑血管疾病、慢性肺部疾病史等相关冠状动脉粥样硬化性心脏病危险因素后,以较大四分位数(Q3)作为截断点将血清CatS水平分为高低两类,结果提示在无冠心病人群及不稳定性心绞痛患者中,CatS水平与是否存在心力衰竭无关(无冠心病组OR=0.86,95%置信区间0.14～5.52,不稳定性心绞痛组OR=2.21,95%置信区间0.53～9.22),而在急性心肌梗死患者中两者则存在强相关性(OR=5.61,95%置信区间1.27～24.75)。结论急性心肌梗死患者血清CatS水平与心力衰竭强相关,可作为除超声外一项评估急性心肌梗死患者是否合并心力衰竭的独立血清标志物。
[Abstract]:Objective to analyze the correlation between serum cathepsin S and heart failure in patients with acute myocardial infarction, and to explore the diagnostic value of serum CatS as a biomarker of acute myocardial infarction with heart failure. Methods from January 1, 2013 to December 30, 2013, selected coronary angiography was performed in the Department of Cardiology, second affiliated Hospital of Zhejiang University Medical College. Myocardial enzyme spectrum and coronary angiography were performed in 147 patients with acute myocardial infarction (including ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction). 107 patients without coronary heart disease and 107 patients with unstable angina pectoris were selected as control group and divided into normal cardiac function group and heart failure group according to the left ventricular ejection fraction (EF) measured by echocardiography for the first time after admission. Arterial blood was collected from all patients before coronary angiography and serum CatS was measured by ELISA. SPSS200 statistical software was used to analyze P05 as statistical significance. Results there were more elderly patients in normal cardiac function group than in heart failure group (mean age of 64.92 12.02 years old vs heart failure group 61.22 12.60 years old). The median levels of serum CatS in the two groups were 6.68 ng / ml ~ 5.55 ~ 7.77 ng / ml ~ (-1) and 5.42 ~ 8.49 ng / ml ~ (-1) respectively. There was no statistical difference between the two groups (P = 0.7058). After adjusting for age and sex, there was no correlation between serum CatS level and left ventricular ejection fraction (LVEF) in two groups. Adjusted height, body weight, body mass index, sex, smoking history, hypertension history, dyslipidemia history, diabetes history, peripheral vascular disease history, cerebrovascular disease, After the risk factors of coronary atherosclerotic heart disease, such as the history of chronic pulmonary disease, the serum CatS levels were divided into two groups by using the larger quartile Q3) as the cut-off point. The results suggest that the level of CatS in patients without coronary heart disease and unstable angina pectoris is not related to the presence of heart failure (ORO 0.86 95% confidence interval 0.145.52 in the non-coronary heart disease group, 0.53 0.31 95% confidence interval 0.53 in the unstable angina pectoris group, and 0.53 卤9.22% confidence interval in the acute myocardial infarction group). In the patients, there was a strong correlation between them. Conclusion the level of serum CatS in patients with acute myocardial infarction is strongly correlated with heart failure and can be used as an independent serum marker for evaluating whether acute myocardial infarction patients are complicated with heart failure.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R542.22

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