血清白细胞介素-6和碱性磷酸酶（ALP）与冠心病病变严重程度的相关性研究

发布时间：2018-06-01 08:41

本文选题：冠状动脉疾病 + 易损斑块　；参考：《山东大学》2017年硕士论文

【摘要】：背景:冠状动脉粥样硬化性心脏病(冠心病,coronary heart disease,CHD)的发病率及死亡率呈逐年上升趋势,严重威胁人类的健康。动脉粥样硬化(Atherosclerosis,AS)斑块破裂和血栓形成是导致急性心血管事件的病理机制。对可能发生破裂的易损斑块(vulnerable plaque)的早期识别成为筛选易损病人(vulnerable patient)以积极干预急性心血管事件进程的重要手段,斑块稳定性也已成为疗效评价的重要依据。AS斑块从稳定变为易损的过程涉及到炎症、免疫、代谢、凝血等多个环节。研究表明,炎症介导参与血栓形成,然而在形成血栓时斑块并不发生破裂,而是因斑块表面糜烂、溃疡、钙化结节形成引发斑块进展。同时,晚近病理检测易损斑块中有少量钙化或点状钙化。因此,我们提出假设,炎症因子,钙化因素共同促进斑块进展。IL-6与动脉粥样硬化的关系已有较多基础及临床研究。研究显示IL-6(high-sensitive C-reactive protein,hs-CRP)可以作为预测冠心病事件的独立危险因素。IL-6为预测炎症的进展及远期心血管危险事件的重要炎性指标。ALP与钙化密切相关,而国内外研究多着眼于参与骨形成及肝相关疾病的研究。ALP是否介导冠心病病变严重程度进展,增加斑块易损性,发生急性冠脉事件,以及炎症因子IL-6与钙化因素ALP与冠心病病变严重程度的相关性研究国内外未见相关报道。因此深入研究IL-6、ALP与冠状动脉粥样硬化性心脏病及斑块稳定性的关系,对探索冠心病与斑块稳定性新的干预靶点具有重要意义。目的:本研究以冠状动脉造影评价冠状动脉病变和Gensini积分量化冠脉病变程度,通过测定急性心肌梗死(acute myocardial infarction,AMI)、不稳定心绞痛(unstable angina pectoris,UAP)、稳定性心绞痛(stab.le angina pectoris,SAP)患者和对照组的血清IL-6和ALP水平,探讨血清IL-6和ALP水平预测冠状动脉病变严重程度及急性冠脉事件的作用。方法:选择经冠状动脉造影术(CAG)确诊的CHD患者60例,其中不稳定型心绞痛(UAP)20例,急性心肌梗死(AMI)20例,稳定型心绞痛(SAP)20例。20例CAG显示无狭窄的患者作为对照组。详细记录患者的病历资料,包括一般临床资料和生化指标。酶联免疫吸附试验(ELISA)法检测4组患者血清IL-6、ALP的水平,同时检测血脂指标、空腹血糖(GLU)等水平。Gensini评分分析冠脉病变程度,相关性分析判断各组IL-6及ALP与Gensini评分的相关关系并进行统计学分析。结果:1.AMI及UAP组的IL-6及ALP血清水平明显高于SAP组及对照组(P均0.01),AMI组IL-6及ALP血清水平显著高于UAP组(P0.05)。2.冠心病组(SAP组+UAP组+AMI组)IL-6及ALP水平分别与Gensini评分呈显著的正相关(r= 0.322,P0.05与r= 0.421,P0.01)3.AMI 组患者 ALP 与 Gensini 评分呈显著的正相关(r=0.674,P0.01)。4.UAP组IL-6与Gensini评分呈显著的正相关(r=0.488,P0.05)。5.SAP组IL-6及ALP水平分别与Gensini评分无相关。结论:IL-6和ALP水平在易损患者中显著增高,提示IL-6和ALP与斑块的不稳定及破裂关系密切。冠心病患者中IL-6和ALP水平随着Gensini积分的增加而升高,说明其与冠脉狭窄程度呈正相关,提示IL-6和ALP参与冠脉进展。AMI组ALP水平与Gensini积分呈正相关,关系密切,提示ALP与冠脉急性事件(心肌梗死)病变严重程度密切相关,ALP可以作为判断ACS病情严重程度的预测指标。
[Abstract]:Background: the incidence and mortality of coronary atherosclerotic heart disease (coronary heart disease, coronary heart disease, CHD) are increasing year by year, which seriously threaten human health. Atherosclerotic (Atherosclerosis, AS) plaque rupture and thrombosis are the pathological mechanism leading to acute cardiovascular events. The vulnerability to possible rupture Early identification of vulnerable plaque has become an important means of screening vulnerable patients (vulnerable patient) to actively intervene in the process of acute cardiovascular events. Plaque stability has also become an important basis for the evaluation of therapeutic effects..AS patches from stable to fragile processes involve inflammation, immunity, metabolism, and coagulation. Inflammation mediates involvement in thrombosis, but the plaque does not break up in the formation of thrombus, but is due to plaque surface erosion, ulcers, and calcified nodules that cause plaque progress. At the same time, there is a small amount of calcification or dot calcification in the late pathological detection vulnerable plaques. Therefore, we hypothesized that inflammatory factors and calcification contribute to plaque progression. The relationship between IL-6 and atherosclerosis has many basic and clinical studies. Research shows that IL-6 (high-sensitive C-reactive protein, hs-CRP) can be used as an independent risk factor for predicting coronary heart disease events.IL-6 is an important inflammatory indicator of the progression of inflammation and the important inflammatory index of long-term cardiovascular risk events.ALP is closely related to calcification, and at home and abroad. The study focuses on whether.ALP is involved in the involvement of bone formation and liver related diseases, whether it mediates the progression of the severity of coronary artery disease, increases plaque vulnerability, causes acute coronary events, and the correlation of inflammatory factors IL-6 and calcification factor ALP to the severity of coronary heart disease, and there are no relevant reports on the severity of coronary heart disease. Therefore, IL-6, ALP The relationship with coronary atherosclerotic heart disease and plaque stability is of great significance for exploring new intervention targets for coronary artery disease and plaque stability. Objective: To evaluate coronary artery lesion and Gensini score to quantify the degree of coronary artery disease by coronary angiography, and to determine acute myocardial infarction (acute myocardial infarctio) by measuring the degree of coronary artery disease. N, AMI), unstable angina pectoris (unstable angina pectoris, UAP), serum IL-6 and ALP levels in patients with stable angina pectoris (stab.le angina pectoris, SAP) and control group, and to explore the role of serum levels and levels in predicting the severity of coronary artery disease and acute coronary events. 60 cases, including 20 cases of unstable angina (UAP), 20 cases of acute myocardial infarction (AMI), 20 cases of stable angina pectoris (SAP), and 20 cases of.20 CAG showed that the patients without stenosis were used as the control group. The patient's medical records were recorded in detail, including general clinical data and biochemical indexes. Enzyme linked immunosorbent assay (ELISA) was used to detect the serum IL-6, ALP water in the 4 groups of patients. At the same time, blood lipid index, fasting blood glucose (GLU) and other level.Gensini scores were used to analyze the degree of coronary artery disease. Correlation analysis was used to determine the correlation between IL-6 and ALP and Gensini scores in each group. Results: the serum levels of IL-6 and ALP in 1.AMI and UAP groups were significantly higher than those of SAP and control groups (P all 0.01). The level of IL-6 and ALP in the group of coronary heart disease (group SAP +UAP +AMI) was significantly higher than that of group UAP (P0.05).2. (group SAP +UAP group), and the level of IL-6 and ALP had a significant positive correlation (r= 0.322, P0.05 and r= 0.421). The levels of IL-6 and ALP in group SAP were not related to the Gensini score. Conclusion: the level of IL-6 and ALP increased significantly in vulnerable patients, suggesting that IL-6 and ALP are closely related to the instability and rupture of plaque. The level of IL-6 and ALP increases with the increase of Gensini integral in patients with coronary heart disease, indicating that it is positively related to the degree of coronary stenosis. The level of ALP in group.AMI was positively correlated with Gensini score, which was closely related, suggesting that ALP was closely related to the severity of acute coronary events (myocardial infarction), and ALP could be used as a predictor of the severity of ACS.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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