急性心肌梗死患者血浆组织蛋白酶L、胱抑素C变化与侧支循环形成的关系

发布时间：2018-08-28 14:15

【摘要】：目的：观察组织蛋白酶L、胱抑素C在急性心肌梗死患者中的变化探讨其与侧支循环形成的关系。方法：临床诊断急性心肌梗死的患者（67例），采集其发病48小时内，第3天，第5天肘静脉血，通过ELISA法测定其血浆组织蛋白酶L水平，乳胶增强散射免疫比浊法测定患者胱抑素C水平。使用Rentrop分级将患者分为侧支循环不良及侧支循环良好组，是否行PCI治疗将其分为急诊PCI组及择期PCI组，是否并发ST抬高等分为ST段抬高型心梗组及非ST段抬高型心梗组。通过组间及亚组的比较分析组织蛋白酶L，胱抑素C在急性心梗患者侧支循环形成中的关系。结果：急性心肌梗死组患者血浆组织蛋白酶L浓度在48小时内，3天，5天呈现先上升而后下降的趋势。侧支循环形成良好组首次静脉血组织蛋白酶L血浆浓度（15.63±6.02nmol/L）比较侧支循环不良组（12.09±4.88nmol/L）明显更高，P0.05，行多因素Logistic分析证明其与侧支循环形成独立相关(OR1.15,95%CI,1.023~1.293,P0.05)。在急诊PCI组与择期PCI组对比第5天静脉血发现择期PCI组患者血浆组织蛋白酶L（29.35±3.36nmol/L）较急诊PCI组（21.57±4.03nmol/L）明显更高，P0.01，，行侧支循环良好与不良亚组分析发现，在择期PCI组中侧支循环丰富患者血浆组织蛋白酶L水平（33.08±3.00nmol/L）较不丰富者（28.15±3.45nmol/L）明显更高，P0.05。提示组织蛋白酶L在可能直接参与了侧支循环形成。此外我们还在对ST段抬高型心肌梗死及非ST段抬高型心肌梗死组的比较中发现，非ST段抬高型心肌梗死首次静脉血组织蛋白酶L浓度（18.97±4.72nmol/L）显著高于ST段抬高型心肌梗死患者（11.34±4.27nmol/L）P0.01。对于血浆胱抑素C的观察可见，除了在第3天急诊PCI组(1.09±0.30mg/L)与择期PCI组（0.89±0.20mg/L）的血浆水平有差异外，其余组间比较未见明显差异。组织蛋白酶L与侧支循环形成良好与否的ROC曲线最佳诊断界值为13.34nmol/L，敏感性67%，特异性63%。结论：血浆组织蛋白酶L是急性心肌梗死患者冠脉侧支循环形成的独立影响因素。组织蛋白酶L可能直接参与了侧支循环的形成过程中。其对侧支循环的形成有一定的预测作用。
[Abstract]:Aim: to investigate the relationship between cathepsin L, cystatin C and collateral circulation in patients with acute myocardial infarction. Methods: Sixty-seven patients with acute myocardial infarction (AMI) were collected and their plasma cathepsin L levels were measured by ELISA method during 48 hours, 3 days and 5 days after the onset of acute myocardial infarction. The level of cystatin C was determined by latex enhanced scattering immunoturbidimetry. The patients were divided into two groups by using Rentrop classification. The patients were divided into two groups: poor collateral circulation and good collateral circulation. The patients were divided into emergency PCI group and selective PCI group, and ST elevation group was divided into ST segment elevation myocardial infarction group and non-ST segment elevation myocardial infarction group. The relationship between cathepsin L and cystatin C in collateral circulation in patients with acute myocardial infarction was analyzed by comparison between groups and subgroups. Results: the plasma cathepsin L concentration in patients with acute myocardial infarction (AMI) increased first and then decreased at 3 days and 5 days within 48 hours. The plasma concentration of cathepsin L (15.63 卤6.02nmol/L) in the group with good collateral circulation formation was significantly higher than that in the group with poor collateral circulation (12.09 卤4.88nmol/L) (P 0.05). Multivariate Logistic analysis showed that the plasma concentration of cathepsin L was independent of collateral circulation (OR1.15,95%CI,1.023~1.293,P0.05). Plasma cathepsin L (29.35 卤3.36nmol/L) was significantly higher in elective PCI group than that in emergency PCI group (21.57 卤4.03nmol/L) on the 5th day compared with that in emergency PCI group (P 0.01). Good collateral circulation and adverse subgroup analysis were found. The plasma cathepsin L level was significantly higher in the selective PCI group (33.08 卤3.00nmol/L) than that in the non-rich group (28.15 卤3.45nmol/L) (P 0.05). It is suggested that cathepsin L may be directly involved in the formation of collateral circulation. In addition, we also found that the concentration of cathepsin L in patients with ST segment elevation myocardial infarction and non ST segment elevation myocardial infarction was significantly higher than that in ST segment elevation myocardial infarction patients (18. 97 卤4.72nmol/L) compared with ST segment elevation myocardial infarction (11. 34 卤4.27nmol/L) P 0. 01. For the observation of plasma cystatin C, there was no significant difference between the other groups except the plasma level of PCI group (1.09 卤0.30mg/L) and selective PCI group (0.89 卤0.20mg/L) on the 3rd day. The best diagnostic limit of ROC curve between cathepsin L and collateral circulation was 13.34 nmol / L, sensitivity was 67nmol / L, specificity was 63g. Conclusion: plasma cathepsin L is an independent factor of coronary collateral circulation in patients with acute myocardial infarction. Cathepsin L may be directly involved in the formation of collateral circulation. The formation of contralateral collateral circulation can be predicted to some extent.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22

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