血清亲环素A在急性心肌梗死患者中的表达及其预后价值

发布时间：2018-06-27 23:37

本文选题：冠心病 + 急性心肌梗死　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:本课题通过检测血清亲环素A(CyPA)在不同程度冠脉病变患者中浓度的变化,并进一步探讨急性心肌梗死患者CyPA浓度与血清B型钠尿肽前体(pro-BNP)水平、左心室大小、射血分数的关系,探讨血清亲环素A浓度在不同冠脉病变程度尤其是急性心肌梗死患者中变化的意义及其对预后评估的价值。方法:1.入组2016年01月01日-2016年09月01日在我科行冠脉造影或急诊冠脉造影的急性前壁心肌梗死患者60例作为研究对象,并选取同期因心绞痛住院的稳定型心绞痛组患者30例作为试验对照组,选取疑似冠心病但行造影检查冠脉光滑无病变的患者为正常对照组30例作为正常对照组,使用ELISA方法测定所有入选对象的血清CyPA水平(CyPA),分析亲环素A在各组间的水平差异,使用SPSS19.0统计学软件进行统计,P0.01差异有统计学意义。2.对急性心肌梗死组患者进一步分析,所有入选的急性心肌梗死患者均为急性前壁心肌梗死,均在发病后12小时内常规服用负荷量双联抗血小板聚集药物,且行冠脉造影明确并成功开通罪犯血管,对冠脉行Gensini积分,并测定其入院后24小时、10天血浆pro-BNP,入院后1月及3月常规行超声心动图检查,记录左室前后径大小(LV)、左室射血分数(LVEF),分析CYPA与上述因子的相关性。结果:1.血清CyPA浓度在急性心肌梗死组患者中最高,其次稳定型心绞痛组高于冠脉正常组,冠脉正常组血清CyPA浓度最低(P0.01);2..急性前壁心肌梗死组患者CyPA浓度与Gensini积分具有很好的线性相关性(r:0.661,p0.001),与10天时的pro-BNP具有相好相关性(r:0.792,p0.001),但与24小时内pro-BNP无线性相关;与发病后1月、3月的LV具有良好的相关性(1月r:0.906,P0.001,3月r:0.839 P0.001),与发病后的动态超声心电图的1月、3月的LVEF呈负的直线相关(1月r:-0.877,P0.001,3月r:-0.792,P0.001)。结论:1.冠心病患者血清CyPA水平高于对照组,表明血清CyPA一定程度上可反应患者冠脉病变程度;2.血清CyPA在急性心肌梗死患者中明显高于稳定型心绞痛患者的血清CyPA,提示在冠脉不稳定斑块形成过程中,亲环素A发挥着一定作用3.在急性心肌梗死患者中可以看到血清CyPA水平与AMI患者心功能变化及近期左心室重构有关,对急性心肌梗死而言,CyPA水平可能是其不良预后的独立危险因素,有助于临床AMI危险分层。
[Abstract]:Objective: to investigate the changes of serum cyclophile A (CyPA) concentration in patients with different degrees of coronary artery disease, and to investigate the levels of CyPA and pro-BNP in patients with acute myocardial infarction (AMI), as well as the size of left ventricle. To explore the significance of the changes of serum cyclophile A concentration in patients with different coronary lesions, especially in patients with acute myocardial infarction (AMI), and its value in evaluating the prognosis of patients with acute myocardial infarction (AMI). Method 1: 1. From January 01, 2016 to September 01, 2016, 60 patients with acute anterior myocardial infarction underwent coronary angiography or emergency coronary angiography in our department. 30 patients with stable angina pectoris who were hospitalized with angina pectoris in the same period were selected as the control group, and 30 patients with suspected coronary heart disease who underwent angiographic examination of smooth coronary artery disease were selected as the normal control group. The serum CyPA level of all the subjects was measured by Elisa, and the level of cyclophile A was analyzed. SPSS 19.0 statistical software was used to analyze the difference between the two groups (P0.01). Further analysis of patients with acute myocardial infarction showed that all patients with acute myocardial infarction were acute anterior wall myocardial infarction and were routinely treated with dual antiplatelet drugs within 12 hours after onset of acute myocardial infarction. The Gensini score of coronary artery was determined and the plasma pro-BNPs were measured 24 hours and 10 days after admission. Echocardiography was performed 1 month and 3 months after admission. Left ventricular anteroposterior diameter (LV) and left ventricular ejection fraction (LVEF) were recorded and the correlation between CYPA and these factors was analyzed. The result is 1: 1. Serum CyPA concentration was the highest in acute myocardial infarction group, followed by stable angina pectoris group higher than coronary normal group, the lowest serum CyPA concentration (P0.01) was found in normal coronary artery group (P0.01). There was a good linear correlation between CyPA concentration and Gensini score (r: 0.661p0.001) and pro-BNP at 10 days (r: 0.792p0.001), but it was correlated with the wireless property of pro-BNP within 24 hours. There was a good correlation between LV in 1 month and LV in 3 months (r: 0.906, P 0.001, r: 0.839, P 0.001). There was a negative linear correlation between LVEF and LVEF in 1 month and 3 months after onset (r: -0.877n, P 0.001, r: -0.792P0.001, respectively). Conclusion 1. The level of serum CyPA in patients with coronary heart disease was higher than that in control group, which indicated that serum CyPA could reflect the degree of coronary artery disease in patients to some extent. Serum CyPA was significantly higher in patients with acute myocardial infarction than in patients with stable angina pectoris, suggesting that cyclin A plays a role in the formation of unstable plaque in coronary artery. In patients with acute myocardial infarction, it can be seen that the level of serum CyPA is related to the changes of cardiac function and left ventricular remodeling in patients with AMI. For acute myocardial infarction, the level of CyPA may be an independent risk factor for poor prognosis. It is helpful for clinical AMI risk stratification.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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