冠心病患者血清白介素-6受体、金属肽酶含血小板反应蛋白基元-1和超敏C反应蛋白与不稳定型斑块相关性研究

发布时间：2018-05-18 12:38

本文选题：不稳定型斑块 + Gensini评分　；参考：《河北北方学院》2015年硕士论文

【摘要】：冠状动脉动脉粥样硬化斑块的形成,发展和破裂过程中炎症反应起着重要作用。目前发现大量的炎症标志物与斑块稳定性相关。其中,白介素-6受体(interleukin 6 receptor,IL-6R)和白介素-6(interleukin 6,IL-6)结合形成复合物,通过心肌细胞丰富的gpl30信号转导受体发挥作用,是动脉粥样硬化重要的炎性标记物。金属肽酶含血小板反应蛋白基元-1(adisintegrin and metalloprotease with thrombospongding type 1 motifs,ADAMTS-1)主要通过上调血管平滑肌细胞的增殖、迁移、凋亡,激活不同的细胞表面分子,参与细胞外基质的降解与重组过程,在冠状动脉粥样斑块的初始、发展及破裂过程发挥重要作用。超敏C反应蛋白(high sensitive C reactive protein,hs-CRP)是急性炎症期IL-6、肿瘤坏死因子(tumor necrosis factor,TNF)及其他细胞因子等刺激肝脏形成的一种急性反应蛋白,是冠心病的独立危险因素。本研究通过观察冠心病血清ADAMTS-1、IL-6R及hs-CRP水平,结合冠脉造影结果Gensini评分、斑块Ambrose分类,探讨ADAMTS-1、IL-6R、hs-CRP与不稳定型斑块关系;通过观察急性冠脉综合症(acute coronary syndromes,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前与术后IL-6R及ADAMTS-1水平,探讨PCI术对不稳定型斑块炎症标记物IL-6R及ADAMTS-1的影响。本研究连续选取我院2013年3月至2013年12月住院24h内完成冠状动脉造影(coronary angiography,CAG)患者328例。诊断为冠心病(coronary heart disease,CHD)272例,包括急性心肌梗死(acute myocardial infarction,AMI)105例、不稳定型心绞痛(unstable angina,UA)126例、稳定型心绞痛(stable angina,SA)41例;冠状动脉无狭窄患者56例为对照组。ACS包括AMI及UA。AMI患者中39例行急诊PCI;42例UA患者行PCI术。所有研究对象入院即刻采静脉血,行PCI术ACS患者于PCI术后12h后再次采静脉血,采用酶联免疫吸附(enzyme linked immunosorbent assay,ELISA)法测定血清IL-6R、ADAMTS-1水平,采用日立7170A型全自动生化分析仪测定hs-CRP,总胆固醇(total cholesterol,TC),甘油三脂(triglycerides,TG)、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)水平。对冠心病患者CAG结果行Gensini评分,采用Ambrose分类评价斑块性质。实验结果表明:AMI组、UA组血清IL-6R、ADAMTS-1水平显著高于SA组、对照组(P0.05);AMI组hs-CRP水平显著高于UA组、SA组、对照组(P0.05);Ambrose分类复杂病变组IL-6R、ADAMTS-1、hs-CRP水平显著高于简单病变组、对照组(P0.05),简单病变组ADAMTS-1水平显著高于对照组(P0.05);采用Pearson相关检验CHD组IL-6R水平与ADAMTS-1水平呈显著正相关(r=0.70,P0.05),IL-6R、ADAMTS-1、hs-CRP水平与Gensini评分无相关性(P0.05);多支病变组、双支病变组及单支病变组各组间IL-6R及ADAMTS-1水平差异无统计学意义(P0.05);PCI术后12h PCI AMI组、PCI UA组IL-6R、ADAMTS-1水平均较入院时升高,差异有统计学意义(P0.05)。综上所述IL-6R、ADAMTS-1及hs-CRP与不稳定型斑块具有相关性,与冠状动脉的狭窄程度及病变的范围无关;ACS患者PCI术后IL-6R、ADAMTS-1水平升高,IL-6R、ADAMTS-1可以预测斑块的不稳定性。
[Abstract]:Inflammation plays an important role in the formation, development and rupture of coronary atherosclerotic plaques. A large number of inflammatory markers are found to be associated with plaque stability. Among them, the interleukin -6 receptor (interleukin 6 receptor, IL-6R) and interleukin -6 (interleukin 6, IL-6) are combined to form complexes and are rich in cardiac myocytes. Gpl30 signal transduction receptor plays an important role in atherosclerosis. Metal peptidase contains platelet reactive protein -1 (adisintegrin and metalloprotease with thrombospongding type 1 motifs, ADAMTS-1), mainly by up regulating the proliferation, migration, and apoptosis of vascular smooth muscle cells, activating different cell surface fractions. The process of degradation and reorganization of the extracellular matrix plays an important role in the initial, development and rupture processes of coronary atherosclerotic plaques. The hypersensitive C reactive protein (high sensitive C reactive protein, hs-CRP) is an acute inflammatory stage IL-6, and the tumor necrosis factor (tumor necrosis factor, TNF) and other cytokines stimulate the formation of the liver. An acute reactive protein, an independent risk factor for coronary heart disease, is an independent risk factor for coronary heart disease. By observing the serum ADAMTS-1, IL-6R, and hs-CRP levels of coronary heart disease, combined with the Gensini score of coronary angiography and Ambrose classification of plaque, the relationship between ADAMTS-1, IL-6R, hs-CRP and unstable plaque was explored, and the acute coronary syndrome (acute coronary syndromes) was observed. ACS) the effect of PCI operation on the inflammatory markers IL-6R and ADAMTS-1 of unstable plaque before and after percutaneous coronary intervention (percutaneous coronary intervention, PCI), and IL-6R and ADAMTS-1 levels. This study selected our hospital from March 2013 to December 2013 to complete the coronary angiography (coronary). Aphy, CAG) 328 patients were diagnosed as coronary heart disease (coronary heart disease, CHD), including 105 cases of acute myocardial infarction (acute myocardial infarction, AMI), 126 cases of unstable angina pectoris (unstable angina), 41 cases of stable angina pectoris, 56 cases of coronary artery stenosis and 56 cases of coronary artery stenosis. In 39 cases, 39 cases were treated with emergency PCI, 42 cases of UA patients were performed PCI operation. All the subjects were admitted to the hospital immediately to collect venous blood. The PCI operation ACS patients recovered the venous blood after PCI after 12h, and used the enzyme linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA) method to determine the serum levels. CRP, total cholesterol (total cholesterol, TC), glycerol three fat (triglycerides, TG), low density lipoprotein cholesterol (low density lipoprotein-cholesterol, LDL-C). In group A and control group (P0.05), the level of hs-CRP in group AMI was significantly higher than that in group UA, group SA and control group (P0.05); the level of IL-6R, ADAMTS-1, hs-CRP in Ambrose classification complex group was significantly higher than that in the simple lesion group, and the control group (P0.05) was significantly higher than that in the control group. There was significant positive correlation (r=0.70, P0.05), IL-6R, ADAMTS-1, hs-CRP level had no correlation with Gensini score (P0.05), and there was no significant difference in IL-6R and ADAMTS-1 levels between the multi branch lesions group and the single branch lesion group (P0.05). Learning significance (P0.05). In summary, IL-6R, ADAMTS-1 and hs-CRP are associated with unstable plaques, not related to the degree of coronary stenosis and the extent of the lesion; IL-6R, ADAMTS-1 levels in ACS patients are elevated, IL-6R, and ADAMTS-1 can predict plaque instability after PCI.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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