血清S100B、S100A6、S100P水平与急性冠脉综合征合并糖尿病的相关性及短期预后研究

发布时间：2018-01-07 17:19

本文关键词：血清S100B、S100A6、S100P水平与急性冠脉综合征合并糖尿病的相关性及短期预后研究　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨血清终末糖化产物受体(RAGE)的配基S100B、S100A6和S100P蛋白水平升高与急性冠脉综合征(Acute coronary syndrome,ACS)的相关性及对不稳定心绞痛患者短期预后的预测价值,研究糖尿病对上述指标的潜在影响。方法:入选882例于2014年3月至2015年2月,于上海交通大学医学院附属瑞金医院心脏科住院且接受冠状动脉造影术(CAG)的患者,根据临床表现、心电图结果、肌钙蛋白水平以及CAG结果,将患者分为对照组(n=251,冠脉造影提示正常或管腔狭窄"f30%),稳定型心绞痛(SA)组(n=211)和ACS组(n=420,包括70例不稳定型心绞痛(UA)患者、90例非ST段抬高型心肌梗死(NSTEMI)和260例ST段抬高型心肌梗死(STEMI)患者);SA和ACS患者依据受累冠脉的数量分为单支、双支和三支病变3个亚组。上述患者于CAG检查使用肝素和硝酸甘油前取外周血5ml,采用酶联免疫吸附法(ELISA法)检测血清S100B、S100A6、S100P、s RAGE水平及CRP、TNF-a水平。跟踪随访UA组患者3个月内的主要心血管不良事件(MACE:心源性猝死、严重心力衰竭、恶性心律失常、再发心肌梗死、靶病变血管重建联合事件)的发生情况。所得数据采用SPSS15.0软件进行分析。结果:(1)三组患者的年龄、性别、体重指数及2型糖尿病比例均无差异,ACS组患者较SA组患者多支病变更为常见(p0.001);(2)ACS组患者血清S100B、S100A6和S100P水平均较其他两组显著升高(均p0.01),SA和对照组之间差异无统计学意义;对照组、SA组、ACS组患者的CRP和TNF-a水平依次显著递升(均P0.01);ACS组的s RAGE水平高于对照组(p0.01),与SA组并无显著差异;ACS亚组分析,STMI患者的S100B、S100A6、S100P、CRP、TNF-a水平均明显高于NSTEMI/UA患者;(3)所有样本及各亚组中糖尿病和非糖尿病病人之间的S100B、S100A6、S100P蛋白水平均无显著差异(all P0.05);(4)血清S100B水平与c Tn I的峰值水平相关(Pearson’s r=0.144,p0.05),S100P水平与CK-MB(Pearson’s r=0.229,p0.001)及c Tn I(Pearson’s r=0.190,p0.01)峰值水平均有相关性。(5)多元回归分析发现,S100B(OR=1.273,95%CI1.024-1.582,P0.05),S100A6(OR=1.451,95%CI1.099-1.915,P0.01),S100P(OR=1.457,95%CI1.099-1.932,P0.01),CRP(OR=1.843,95%CI1.398-2.429,P0.001),TNF-a(OR=1.453,95%CI1.176-1.795,P0.01)水平与ACS发病独立相关;(6)对70例UA患者跟踪随访3个月,随访结束时,有8人失访,22人发生了终点事件,发生MACE的患者与未发生临床不良心血管事件的患者相比较,有着较高的CRP、S100B、S100A6、S100P水平,多元回归分析结果显示,多支病变和S100B、S100A6、S100P水平与随访3个月MACE独立相关。结论:1、ACS组患者血清S100B、S100A6、S100P水平较慢性稳定性冠心病患者明显升高,与ACS的发生独立相关,且S100B、S100P与心肌缺血的严重程度相关,并可预测UA患者的短期心脏不良事件。2、糖尿病环境对血清S100B、S100A6、S100P的水平无显著影响。
[Abstract]:Objective: to study the ligand S100B of serum terminal glycosylation product receptor (rag). Increased S100A6 and S100P protein levels were associated with acute coronary syndrome in acute coronary syndrome. Methods: 882 patients with unstable angina pectoris were selected from March 2014 to February 2015 to study the potential effect of diabetes mellitus on the above indexes. Patients who were hospitalized in cardiac department of Ruijin Hospital affiliated to Shanghai Jiaotong University and underwent coronary angiography (CAG) were analyzed according to clinical manifestation, electrocardiogram (ECG), troponin level and CAG results. The patients were divided into control group (n = 251) and ACS group (n = 420). Coronary angiography showed normal or luminal stenosis (F30) and stable angina pectoris (SAA) group (n = 211). There were 70 patients with unstable angina pectoris and 90 patients with non-ST-segment elevation myocardial infarction (NSTEMI) and 260 patients with ST-segment elevation myocardial infarction (STEMI). Patients with SA and ACS were divided into three subgroups according to the number of involved coronary arteries: single vessel, double vessel and three vessel lesion. The peripheral blood was collected from 5 ml patients before CAG examination with heparin and nitroglycerin. Elisa was used to detect the serum S100BX S100A6 and S100Pu s RAGE level and CRP. TNF-a level. The main cardiovascular adverse events in UA group were followed up for 3 months: sudden cardiac death, severe heart failure, malignant arrhythmia, and recurrent myocardial infarction. The data were analyzed by SPSS15.0 software. Results the age and sex of the three groups were analyzed. There was no significant difference in body mass index (BMI) and the proportion of type 2 diabetes mellitus between ACS group and SA group. The serum levels of S100BnS100A6 and S100P in the ACS group were significantly higher than those in the other two groups (P < 0.01). The levels of CRP and TNF-a in the control group (P < 0.01) were significantly higher than those in the control group (P < 0.01). The level of s RAGE in ACS group was higher than that in control group (p0.01), and there was no significant difference between ACS group and SA group. ACS subgroup analysis showed that the levels of S100Bmb S100A6, S100PfU, CRPnF-a in STMI patients were significantly higher than those in NSTEMI/UA patients. (3) there was no significant difference in the protein levels of S100BnS100A6, S100A6, S100P between diabetic and non-diabetic patients in all samples and subgroups. (4) the serum S100B level was correlated with the peak level of c TnI. The level of S100P was 0.229p 0.001 and 0.190, respectively. Multiple regression analysis showed that S100BORA 1.27395CI1.024-1.582P0.05). S100A6 / OR1. 451 / 95 / CI1.099-1.915 / P0.01 / S100P0 / OR1.4557. 95 CI1.099-1.932 P0.01C CRPO 1.84395 CI1.398-2.429 P0.001). The level of CI 1.176-1.795P0.01) was independently correlated with the incidence of ACS. (6) 70 patients with UA were followed up for 3 months. At the end of follow-up, 8 patients lost their visit and 22 patients had terminal events. Compared with those with no adverse cardiovascular events, the patients with MACE had a higher level of S100A6 S100P, the results of multiple regression analysis showed that there was no adverse cardiovascular events in patients with MACE. The level of S100A6 and S100A6 S100P in patients with multiple vessel lesions was independently correlated with MACE for 3 months. Conclusion the serum levels of S100BnS100A6 in the patients with S100BmA6 were significantly higher than those in the control group (P < 0. 05). The level of S100P was significantly higher than that of patients with chronic stable coronary heart disease, which was independent of the occurrence of ACS, and the severity of myocardial ischemia was correlated with the level of S100P. The short-term adverse cardiac events of UA patients were predicted. 2. Diabetic environment had no significant effect on the serum S100Bmb S100A6A6 S100P level.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4;R587.1

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