【摘要】目的探讨急性心肌梗死(AMI)患者血浆脂联素(APN)和超敏C反应蛋白(hsCRP)的变化及其临床意义。方法选择AMI患者50例,入院后均行超声心动图检查评价室壁运动和心功能,并设对照组(30例)进行比较。采用ILISA法测定APN,免疫散射比浊法检测hsCRP水平。结果AMI患者APN水平显著低于正常心功能对照组(P<0.01),hsCRP水平显著高于正常心功能对照组(P<0.01)。AMI患者APN、hsCRP水平与左心室射血分数(LVEF)呈负相关(r=0.549,P<0.01)。结论血浆APN、hsCRP水平与预后显著相关,对AMI的辅助诊断、疗效观察及预后判断具有重要价值。
　　【关键词】
　　急性心肌梗死;脂联素;超敏C反应蛋白
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　　Clinical analysis of plasma adiponectin and hsCRP in patients with acute myocardial infarction
　　
　　MA Xiangwen,WANG Xian,LI Jian.Department of Endocrinology,Women and Children Hospital,Weifang,Shangdong Province 261011,China
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　　【Abstract】ObjectiveTo explore the variation and significance of plasma adiponectin(APN)and high
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　　sensitivety Creactive protein(hsCRP)in patients with acute myocardial infarction(AMI).MethodsThe cases were divided into two groups:AMI group(including 50 AMI patients)and control group(including 30 normal individuals).Plasma concentration of APN was measured by ILISA and hsCRP was measured by immue nephelonretry.ResultsThe concentration of APN in patients with AMI were significantly lower than those in the control group(P<0.01),hsCRP were significantly higher than those in the control group(P<0.01).The concentration of APN and hsCRP in AMI patients had a parallel rationship with LVEDD(r=0.549,P<0,01).ConclusionPlasma APN and hsCRP levels are of great value to the diagnosis,treatment and prognosis of AMI.
　　【Key words】
　　Acute myocardial infarction; Adiponectin; High sensitivity Creactive protein
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　　脂肪组织是功能活跃的内分泌器官,可表达和分泌多种参与胰岛素抵抗发生的脂肪细胞因子如肿瘤坏死因子α(TNFα)、抵抗素、瘦素、脂联素等[1]。脂联素(APN)是脂肪细胞分泌的众多激素中的一种。研究表明[2],APN具有调节糖脂代谢、抗IR、抗炎及抗动脉硬化(AS)等功能,在减少心血管疾病的多种危险因素方面发挥着重要的作用。CRP被认为是动脉粥样硬化性血栓形成疾病的介导和标志物[4,5]。本文检测了50例AMI患者和30例对照组的APN和hsCRPde水平,并评估其对AMI的危险分层及判断预后的价值。
　　
　　1对象与方法
　　
　　1.1对象选择2006年7月至2008年7月在我院住院的AMI患者50例,其中男34例,女16例,年龄45岁~81岁,平均(57.31±5.23)岁,均符合WHO关于AMI的诊断标准:典型的胸痛持续时间>30 min;ST段上抬>0.2 mv;血清心肌酶谱升高大于正常2倍以上。对照组30例,男21例,女9例,年龄34~74岁,平均年龄54.42±6.42岁,均为健康体检者。经病史、体检和辅助检查,排除心、脑、肾和糖尿病等疾患,未服用任何药物。
　　
　　1.2方法APN测定用酶联免疫吸附试验(ELISA法),试剂盒由美国Bionewtrans Pharmaciutical Biotechnology Co,Ltd生产(大连泛邦化工技术开发有限公司提供),试剂盒检测线形范围为0.75~30 mg/L,敏感度为0.1 mg/L。同时采用AU2700全自动生化分析仪(日本Olympus公司),应用乳胶增强免疫透射比浊法测定血浆hsCRP水平。待标本收集完全后同批测定两组血浆APN、hsCRP水平。应用美国惠普5500彩色多普勒血流仪行超声心动图检查,采用面积长轴法测定左室射血分数(LVEF)。超声诊断仪所用技术参数对所有的测试对象相同,并且至少测量3个连续周期,取其平均值,并与测定血浆APN、hsCRP水平同期进行。
　　
　　1.3统计学方法计量资料以均数±标准差(x±s)表示,并进行正态齐性检验;组间资料比较用单因素方差分析,计数资料用χ2检验,相关检验使用回归分析。用SPSS 11.5统计软件进行分析处理。
　　
　　2结果
　　
　　AMI患者APN水平显著低于正常心功能对照组(P<0.01),hsCRP水平显著高于正常心功能对照组(P<0.01)。AMI患者APN、hsCRP水平与左心室射血分数(LVEF)呈负相关(r=0.549,P<0.01)。见表1。
　　
　　表1
　　
　　两组血浆APN、hsCRP水平和超声指标检测结果比较(x±s)
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　　组别例数APN(mg/L)hsCRP(mg/L)LVEF(%)
　　对照组305.21±0.360.45±0.103.47±1.15
　　治疗组503.41±0.47*7.65±2.97*6.45±1.24*
　　注:与对照组比较*P<0.01
　　
　　3讨论
　　
　　近年来研究表明,脂肪组织是机体能量代谢过程中起关键作用的内分泌器官[6],它可分泌多种脂肪因子,这些因子通过内分泌、旁分泌和自分泌方式不仅参与调节机体的能量代谢,还与胰岛素抵抗、心血管疾病的发生密切联系。血浆脂联素水平在冠心病及其他大血管病变中明显降低[7,8],与心血管病变密切相关,如脂联素可降低肿瘤坏死因子α刺激的黏附分子的表达[9],抑制外周单核细胞的生长和炎症因子的释放[10],具有保护内皮、抗炎、拮抗动脉粥样硬化的功能[11]。本研究结果表明AMI后APN浓度明显低于对照组(P<0.01),故认为血浆APN的检测可能对评估AMI的发生有重要意义。
　　CRP是一种在肝细胞内合成的,在急性时相反应中变化最显著、最敏感、最重要的急性时相蛋白质,是反映机体炎性反应的客观指标,也是预测冠心病危险性的强有力指标,调节CRP含量可控制动脉粥样硬化的进展[12,13]。此外近年来多项大规模前瞻性研究证实hsCRP是健康人群将来发生心肌梗死和脑卒中强烈的独立预测因子[14]。本研究显示AMI患者中hsCRP浓度显著高于对照组。
　　综上所述,血浆APN浓度在AMI患者中明显降低,而hsCRP水平明显升高,且二者与左心室射血分数(LVEF)呈负相关,这些研究提示APN和hsCRP测定将是AMI危险分层的必要手段之一,同时二者结合对于判断AMI预后也有很高的预测价值。
　　
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