血清乳脂球表皮生长因子-8在心肌缺血再灌注损伤中的表达及意义

发布时间：2018-11-03 06:52

【摘要】：目的:探讨血清乳脂球表皮生长因子-8(Milk fat globule epidermal growth factor-8,MFG-E8)在急性心肌梗死(Acute myocardial infarction,AMI)患者心肌缺血再灌注损伤(Myocardial ischemia reperfusion injury,MIRI)过程中的表达,以及(MFG-E8与超敏C反应蛋白(high-sensitivity C-reactive protein,Hs-CRP)、白介素-6(Interleukin-6,IL-6)相关性的研究。方法:选择2014年1月至2014年8月因急性心肌梗死于济宁医学院附属医院就诊,且发病6小时之内,经绿色通道行PCI治疗的ST段抬高型心肌梗死(ST elevated myocardial infarction,STEMI)患者40例作为AMI组,另选择同期因胸部不适于我院心内科住院治疗,并行冠脉造影检查,结果示冠脉未见明显狭窄病变的患者30例作为对照组。两组患者均于PCI或冠状动脉造影(Coronary angiography,CAG)术前、术后24小时、术后48小时抽取静脉血5ml,离心后保存于-80°C冰箱中。所有患者均于入院当日行肌钙蛋白、肌酸激酶同工酶、BNP、肝功能、肾功能、血脂、血糖监测,同时记录心肌梗死相关血管开通后出现的心律失常类型,进一步追踪住院期间发生不良事件的情况(如再发心肌梗死、心力衰竭、心源性休克、心源性猝死、严重心律失常等)。标本收集完毕后,用ELISA法检测血清MFG-E8、Hs-CRP、IL-6水平,比较不同时间点上各因子水平变化。用SPSS18.0软件进行统计学分析。结果:(1)AMI组各时间点血清MFG-E8水平均低于相应时间点对照组,组间差异有统计学意义(P=0.003、P=0.006、P=0.002)。AMI组血清MFG-E8水平术后24小时较术前出现明显升高(P=0.006),且术后48小时血清mfg-e8水平继续升高,与术前、术后24小时组间差异有统计学意义(p=0.005、p=0.001)。对照组术前、术后24小时、术后48小时血清mfg-e8水平组间比较差异无统计学意义(p=0.067、p=0.059、p=0.150)。(2)ami组各时间点血清hs-crp水平均高于相应时间点对照组,组间差异有统计学意义(p=0.012、p=0.006、p=0.005)。ami组血清hs-crp水平术后24小时较术前出现明显升高(p=0.002);术后48小时血清hs-crp水平较术后24小时明显下降(p=0.008),但较术前仍明显升高(p=0.005)。对照组术前、术后24小时、术后48小时血清hs-crp水平组间比较差异无统计学意义(p=0.100、p=0.350、p=0.058)。(3)ami组各时间点血清il-6水平均高于相应时间点对照组,组间差异有统计学意义(p=0.009、p=0.003、p=0.028)。ami组血清il-6水平术后24小时较术前出现明显升高(p=0.002);术后48小时血清il-6水平继续升高,与术前、术后24小时组间差异有统计学意义(p=0.003、p=0.001)。对照组术前、术后24小时、术后48小时血清il-6水平组间比较差异无统计学意义(p=0.055、p=0.140、p=0.320)。(4)ami组各时间点血清mfg-e8水平与hs-crp水平呈负相关(r=-0.774,p=0.003;r=-0.462,p=0.006;r=-0.744,p=0.008),与il-6水平呈负相关(r=-0.514,p=0.006;r=-0.408,p=0.005;r=-0.439,p=0.004);ami组各时间点血清hs-crp水平与il-6水平呈正相关(r=0.434,p=0.003;r=0.436,p=0.008;r=0.399,p=0.001)。(5)ami组中心肌梗死相关血管(ira)开通即刻均观察到再灌注心律失常的发生(ra),包括:窦性心动过缓、室性早搏、房性早搏、室颤、房室传导阻滞、窦性停搏、室性心动过速。(6)根据术后24小时的bnp是否正常,将ami组患者分为bnp异常组和bnp正常组,其中bnp异常组患者较正常者各时间点mfg-e8水平均明显降低(p=0.003)。(7)根据住院期间是否发生不良事件,将AMI组患者分为发生不良事件组及未发生不良事件组,发生院内不良事件患者较未发生不良事件患者各时间点MFG-E8水平明显降低(P=0.012)。结论:(1)MFG-E8参与了AMI患者PCI手术治疗中MIRI的过程,在此过程中可能是通过抑制炎性细胞因子Hs-CRP、IL-6释放,而参与MIRI过程。(2)MFG-E8对于急性心肌梗死患者远期预后有一定的预测价值。
[Abstract]:Objective: To investigate the expression of serum milk fat ball epidermal growth factor-8 (MFG-MAA) in acute myocardial infarction (AMI) patients with myocardial ischemia-reperfusion injury (MIRI) and (MFG-VEP) and hypersensitive C-reactive protein (Hs-CRP). Study on the correlation between interleukin-6 (interleukin-6, IL-6). Methods: 40 patients with ST-segment elevation myocardial infarction (STEMI) treated with PCI were treated as AMI group from January 2014 to August 2014 due to acute myocardial infarction. During the same period, the chest was not suitable for hospitalization in our hospital, and coronary angiography was performed in parallel. The results showed that 30 patients with no obvious stenosis were treated as control group. Two groups of patients were treated with PCI or coronary angiography (CAG), 24 hours after operation, 5 ml of venous blood were taken after 48 hours of operation, and then stored in -80 掳 C refrigerator after centrifugation. All patients had cardiac troponin, creatine kinase isoenzymes, BNP, liver function, renal function, blood lipid and blood glucose monitoring on the day of admission, and also recorded the type of arrhythmia that occurred after myocardial infarction related blood vessels were opened. Further tracking of adverse events during hospitalization (e.g., recurrent myocardial infarction, heart failure, cardiogenic shock, sudden cardiac death, severe arrhythmia, etc.). After the samples were collected, the levels of MFG-, Hs-CRP and IL-6 were detected by ELISA, and the levels of various factors were compared at different time points. Statistical analysis was performed with SPSS18. 0 software. Results: (1) The levels of MFG and MFG in each time point of AMI group were lower than those of control group at corresponding time point (P = 0.0003, P = 0.0006, P = 0.0002). The level of mfg-e8 in serum of AMI group increased significantly at 24 hours after operation (P = 0.0006), and the level of mfg-e8 in serum of AMI group continued to increase within 48 hours after operation (p = 0.0005, p = 0.0001). There was no significant difference in serum mfg-e8 levels after operation (p = 0.067, p = 0.059, p = 0.150). (2) The levels of hs-crp in each time point of ami group were higher than those of control group at corresponding time point (p = 0.0012, p = 0.0006, p = 0.0005). The serum hs-crp levels in the ami group increased significantly at 24 hours after operation (p = 0.0002), and the serum hs-crp level decreased significantly at 48 hours after operation (p = 0.0008), but still increased significantly before operation (p = 0.0005). There was no significant difference (p = 0.100, p = 0.350, p = 0.058) between the levels of hs-crp in serum before and after operation. (3) The level of serum IL-6 in each time point of the ami group was higher than that of the control group at the corresponding time point (p = 0.0009, p = 0.0003, p = 0.028). The serum IL-6 level in the ami group increased significantly before operation (p = 0.0002), and the serum IL-6 level continued to increase within 48 hours after operation (p = 0.0003, p = 0.0001). There was no significant difference in serum IL-6 group after operation (p = 0.055, p = 0.140, p = 0.320). (4) The level of mfg-e8 in each time point of the ami group was negatively correlated with the hs-crp level (r =-0.474, p = 0.003; r =-0.462, p = 0.00006; r =-0.474, p = 0.00008), negatively correlated with the level of il-6 (r =-0.408, p = 0.00005; r =-0.439, p = 0.00004); the level of hs-crp in each time point of the ami group was positively correlated with the il-6 level (r = 0.434, p = 0.00003; r = 0.436, p = 0.0008; r = 0.9399, p=0.001). (5) The occurrence (ra) of reperfusion arrhythmia was observed immediately after the opening of the infarct-related blood vessel (ira) in the ami group, including: slow onset, premature ventricular premature beat, atrial premature beat, ventricular fibrillation, atrioventricular block, atrial arrest, ventricular tachycardia. (6) According to whether bnp was normal at 24 hours after operation, the patients were divided into the bnp abnormal group and the bnp normal group, among which, the mfg-e8 levels in the bnp abnormal group were significantly lower than those in each time point mfg-e8 (p = 0. 003). (7) According to the occurrence of adverse events during hospitalization, the patients of AMI group were divided into adverse event group and no adverse event group, and the MFG-VEP level was significantly lower in patients with adverse events in hospital than those in the absence of adverse events (P = 0.0012). Conclusion: (1) MFG-NHL is involved in the process of MIRI in patients with AMI, and may be involved in MIRI process by inhibiting inflammatory cytokines Hs-CRP and IL-6 release. (2) MFG-MAA has a certain predictive value for the long-term prognosis of patients with acute myocardial infarction.
【学位授予单位】：济宁医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R542.22

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