急性冠脉综合征患者血清高迁移率族蛋白B1的表达及PCI围术期强化阿托伐他汀干预治疗的影响

发布时间：2018-01-03 08:45

  本文关键词：急性冠脉综合征患者血清高迁移率族蛋白B1的表达及PCI围术期强化阿托伐他汀干预治疗的影响　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 急性冠脉综合征血管成形术 经腔 经皮冠状动脉 高迁移率族蛋白B1 基质金属蛋白酶-9 C反应蛋白 阿托伐他汀

【摘要】：目的观察血清高迁移率族蛋白B1(HMGB1)、超敏C反应蛋白(hs-CRP)及基质金属蛋白酶-9(MMP-9)在急性冠脉综合征(ACS)患者中的表达,探讨其与ACS的关系;探讨围手术期强化阿托伐他汀干预治疗对ACS患者经皮冠状动脉介入治疗(PCI)术后HMGB1、hs-CRP及MMP-9的影响及其临床意义。方法1、连续选取在2014年5月到2015年5月期间因急性胸痛入住天津市胸科医院,行冠状动脉造影(CAG)后确诊为ACS,并同时行首次PCI治疗的患者120例;另选取同时段就诊于我院并经CAG检查除外冠心病(CHD)的患者106例,作为对照组。全部入组患者均于介入术前采取空腹肘静脉血,检测血清HMGB1、hs-CRP及MMP-9水平,并利用全自动生化分析仪分析血脂、同型半胱氨酸(HCY)及氨基末端脑钠尿肽原(NT-proBNP)等生化指标。依据患者冠脉病变的支数将ACS患者分为3组:单支冠脉病变组(44例),双支冠脉病变组(40例)及三支冠脉病变组(36例),分析血清HMGB1、hs-CRP及MMP-9水平在各组间的水平差异;采取Logistic回归分析法分析ACS的危险因素,并探讨ACS患者血清HMGB1水平与hs-CRP、MMP-9水平以及其他ACS危险因素间的相关关系。2、按照随机数字表法将ACS组患者分为两组,即标准组(60例)和强化组(60例),PCI术前分别给予两组患者阿托伐他汀钙片20mg顿服和40mg顿服治疗,术后分别继续予以阿托伐他汀钙片20mg每天1次和40mg每天1次治疗,并于PCI术后24h、1周再次采取空腹肘静脉血,用ELISA法分析HMGB1、hs-CRP及MMP-9水平;并于PCI术前及术后1月行心脏超声检测ACS患者左心室舒张末期内径(LVEDD)及左室射血分数(LVEF),并于PCI术后1个月复查氨基末端脑钠尿肽原(NT-proBNP);随访6个月观察这期间两组ACS患者主要不良心脏事件(MACE)的发生情况。结果1、ACS组患者血清HMGB1、hs-CRP、MMP-9及NT-proBNP水平均显著高于对照组患者,差异有统计学意义(均P0.05);且冠脉病变程度加重,血清HMGB1、hs-CRP、MMP-9水平也随之升高(均P0.05)。2、相关性分析结果显示,HMGB1水平、hs-CRP水平与ACS呈正相关关系,高密度脂蛋白胆固醇(HDL-C)与ACS呈负相关关系(均P0.05);且ACS组患者血清HMBG1水平与hs-CRP水平呈正相关关系(γ=0.300,P0.05)。3、PCI术前,标准组与强化组患者血清HMGB1、hs-CRP及MMP-9水平差异无统计学意义(P0.05)。术后24h,两组患者血清HMGB1、hs-CRP及MMP-9水平均较术前明显升高,差异有统计学意义(均P0.05);但两组患者间无明显差异(P0.05)。术后1周,标准组与强化组患者血清HMGB1、hs-CRP及MMP-9水平均较术后24h降低,且强化组下降更显著(均P0.05),与术前相比,标准组患者上述炎症因子水平仍显著升高(均P0.05),但强化组患者升高已不明显,差异无统计学意义(均P0.05)。4、与PCI术前相比,术后1个月,标准组与强化组患者的LVEDD及NT-proBNP水平均较术前降低,LVEF较术前升高(均P0.05),但两组间差异无统计学意义(均P0.05);截止到随访结束(PCI术后6个月),强化组及标准组患者发生主要不良心脏事件(MACE)的患者总数分别为:3例和8例,差异有统计学意义(P0.05)。结论1、ACS患者的血清HMGB1的水平显著升高,而且与ACS呈正相关,它可能是ACS的一种危险因素。HMGB1与hs-CRP相互影响,在动脉粥样硬化和ACS的发病机制中发挥着重要作用。2、早期应用强化阿托伐他汀钙片治疗更能显著降低PCI术后急性期ACS患者HMGB1的表达,减轻ACS患者急性期的炎症反应,稳定冠脉粥样硬化斑块,改善其心功能及短期预后,且其短期内的安全性良好。
[Abstract]:Objective To observe the serum high mobility group protein B1 (HMGB1), high sensitive C reactive protein (hs-CRP) and matrix metalloproteinase -9 (MMP-9) in patients with acute coronary syndrome (ACS) patients, and explore its relationship with ACS; to evaluate the perioperative intensive atorvastatin therapy on the treatment of percutaneous coronary intervention arterial intervention in patients with ACS (PCI) after HMGB1, hs-CRP and MMP-9 and its clinical significance. Methods 1, continuous selection in May 2014 to May 2015 in Tianjin Thoracic Hospital due to acute chest pain, coronary artery angiography (CAG) were diagnosed as ACS, and for the first time in 120 cases of patients treated with PCI were selected at the same time to visit; in our hospital and examined by CAG except for coronary heart disease (CHD) in 106 cases of patients, as control group. All patients in the preoperative intervention take fasting venous blood, serum HMGB1, hs-CRP and MMP-9 level, and the use of automatic biochemical analyzer Analysis of blood lipid, homocysteine (HCY) and N-terminal pro brain natriuretic peptide (NT-proBNP) and other biochemical indicators. On the basis of coronary artery lesions in patients with the number of ACS patients were divided into 3 groups: single vessel coronary artery disease group (44 cases), double vessel coronary disease group (40 cases) and coronary artery lesion group (three 36 cases), analysis of serum HMGB1, hs-CRP level and MMP-9 level in the differences between groups were taken; Logistic regression analysis of risk factors of ACS analysis method, and to investigate the levels of serum HMGB1 in patients with ACS and hs-CRP, MMP-9 and other ACS risk factors and the correlation between.2, according to the random number table method were divided into ACS group into two groups, namely the standard group (60 cases) and intensive group (60 cases), preoperative PCI were treated with two groups of Atorvastatin Calcium Tablets 20mg and 40mg meal meal treatment respectively, continue to be the Atorvastatin Calcium Tablets 20mg 1 times a day and 40mg 1 times a day after treatment, PCI and 24h after operation, 1 weeks again Take the venous blood, HMGB1 analysis using ELISA method, hs-CRP and MMP-9; and in January for cardiac ultrasound detection of ACS in patients with left ventricular end diastolic diameter PCI before and after surgery (LVEDD) and left ventricular ejection fraction (LVEF), and PCI 1 months after the treatment, N-terminal brain natriuretic peptide (NT-proBNP); after 6 months of follow-up observation of the two groups during ACS in patients with major adverse cardiac events (MACE). The incidence of the 1 groups of patients with ACS, HMGB1, hs-CRP, MMP-9 and NT-proBNP were significantly higher than those in control group, the difference was statistically significant (P0.05); and the severity of coronary lesion serum HMGB1, hs-CRP, MMP-9, along with elevated levels of.2 (P0.05), correlation analysis showed that the HMGB1 level, hs-CRP level was positively correlated with ACS, high density lipoprotein cholesterol (HDL-C) was negatively correlated with ACS (P0.05); and group ACS serum level of HMBG1 and hs-CRP in water 骞冲憟姝ｇ浉鍏冲叧绯，

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