急性心肌梗死合并2型糖尿病患者血清PCSK9的水平变化及其与HbAlc、Hs-CRP的相关性分析

发布时间：2018-05-01 05:08

本文选题：前蛋白转化酶枯草溶菌素9 + 急性心肌梗死　；参考：《石河子大学》2017年硕士论文

【摘要】：目的:观察前蛋白转化酶枯草溶菌素9(PCSK9)在急性心肌梗死合并2型糖尿病患者中的水平,并探讨其与血糖控制水平、炎症反应之间的关系。方法:选取急性心肌梗死合并2型糖尿病患者100例,同期住院的单纯急性心肌梗死患者61例,慢性稳定性冠心病患者70例。急性心肌梗死的诊断标准符合2011年ESC“急性心肌梗死诊断和治疗指南”中的相关诊断标准;糖尿病的诊断标准符合2013年ADA糖尿病医学诊疗标准。收集患者的临床基本资料,并严格按照中华医学会心血管病学分会制定的《经皮冠状动脉介入治疗指南(2012)》对入选患者行冠脉造影检查,并采用Gensini积分系统对患者冠状动脉的狭窄程度给予定量评价;各组入选患者入院后第二天空腹采取静脉血,采用贝克曼AU5800全自动生化分析仪测定患者高敏C反应蛋白(Hs-CRP)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、总胆固醇(TC)水平;采用BIO-RAD公司D-10全自动糖化血红蛋白分析仪检测患者糖化血红蛋白(HbA1c);采用酶联免疫吸附试验(ELISA)检测患者血清PCSK9水平;并将血清PCSK9水平与反映血糖控制水平的HbA1c以及炎症指标Hs-CRP之间进行相关性分析。结果:急性心肌梗死合并2型糖尿病组、单纯急性心肌梗死组、慢性稳定性冠心病组三组患者在年龄、性别、吸烟史、高血压病史、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白等各方面的比较差异均无统计学意义(P0.05),三组间空腹血糖水平比较差异有统计学意义(P0.05);急性心肌梗死合并糖尿病组、单纯急性心肌梗死组血清PCSK9、HbA1c、Hs-CRP水平均较慢性稳定性冠心病组高,且急性心肌梗死合并糖尿病组三者水平均较单纯急性心肌梗死组高(P0.05);在急性心肌梗死合并糖尿病组中,血清PCSK9水平与Hs-CRP、Gensini评分呈正相关(r分别为0.526、0.287,P均0.05),与HbA1c、空腹血糖水平无相关性(r分别为0.067、0.118,P0.05)。结论:1、急性心肌梗死合并糖尿病患者血清PCSK9水平较高,提示PCSK9可能参与了促冠脉斑块的不稳定性及糖代谢紊乱的过程。2、血清PCSK9在急性心肌梗死合并糖尿病患者中与冠状动脉Gensini评分、hs-CRP存在正相关关系,提示检测PCSK9有助于协助判断患者冠脉病变的严重程度。
[Abstract]:Aim: to observe the level of proprotein converting enzyme lysogenin 9 (PCSK9) in patients with acute myocardial infarction (AMI) complicated with type 2 diabetes mellitus (T2DM), and to explore the relationship between PCSK9 and blood glucose control level and inflammatory response. Methods: 100 patients with acute myocardial infarction complicated with type 2 diabetes mellitus, 61 patients with simple acute myocardial infarction and 70 patients with chronic stable coronary heart disease were selected. The diagnostic criteria for acute myocardial infarction are in accordance with the relevant diagnostic criteria in the ESC guidelines for the diagnosis and treatment of Acute Myocardial Infarction in 2011, and the diagnostic criteria for diabetes are in line with the 2013 ADA Diabetes Medical criteria. Collect the basic clinical data of the patients, and strictly follow the guidelines for percutaneous coronary intervention made by the Chinese Medical Association's Cardiovascular Association Branch (2012), and perform coronary angiography examination on the selected patients. The degree of coronary artery stenosis was evaluated quantitatively by Gensini integral system, and the venous blood was taken on an empty stomach on the second day after admission. The levels of Gao Min C-reactive protein (Hs-CRP), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride (TG) and total cholesterol (TC) were measured by Beckmann AU5800 automatic biochemical analyzer. HbA1cU was detected by D-10 automatic glycosylated hemoglobin analyzer of BIO-RAD Company, and serum PCSK9 level was detected by enzyme linked immunosorbent assay (Elisa). The correlation between serum PCSK9 level, HbA1c, which reflects the level of blood glucose control, and Hs-CRP, an inflammatory index, was analyzed. Results: age, sex, smoking history, history of hypertension, triglyceride, total cholesterol, high density lipoprotein (HDL) in patients with acute myocardial infarction complicated with type 2 diabetes mellitus, simple acute myocardial infarction and chronic stable coronary heart disease were studied. There was no significant difference in all aspects of low density lipoprotein (LDL), but there was significant difference in fasting blood glucose level among the three groups (P 0.05), and there was no significant difference in acute myocardial infarction (AMI) complicated with diabetes mellitus group (P 0.05). The serum levels of PCSK9 HbA1chs-CRP in patients with AMI were higher than those in patients with chronic stable coronary heart disease, and the levels of Hs-CRP in patients with acute myocardial infarction complicated with diabetes were higher than those in patients with acute myocardial infarction and diabetes mellitus. The positive correlation between serum PCSK9 level and Hs-CRP Gensini score was 0. 526 卤0. 287 (P < 0. 05), and there was no correlation between serum PCSK9 level and HBA _ (1) (P < 0. 05). Conclusion the serum PCSK9 level in patients with acute myocardial infarction and diabetes mellitus is higher than that in control group. The results suggest that PCSK9 may be involved in the process of coronary plaque instability and glucose metabolism disorder. There is a positive correlation between serum PCSK9 and coronary Gensini score in patients with acute myocardial infarction and diabetes mellitus. The results suggest that the detection of PCSK9 is helpful in judging the severity of coronary artery disease.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22;R587.1

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