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目的观察老年急性冠状动脉综合征(ACS)患者在病程早期的血浆组织因子(TF)、基质金属蛋白酶(MMP)-1水平,以及组织因子途径抑制物(TFPI)-2的变化规律,探讨TFPI-2在ACS发病机制及病情监测中的意义。方法连续入选2008年3月—2009年3月在复旦大学附属华山、华东医院住院,年龄≥60岁的患者,根据临床表现、冠状动脉造影检查结果分别入选ACS组及稳定型心绞痛(SAP)组。冠状动脉造影检查正常的老年健康者入选正常组。ACS组分别于入院24h内及发病后2、4周采集外周静脉血,SAP、正常组于入院24h内采集外周静脉血,采用酶联免疫吸附试验检测血浆TF、TFPI-2及MMP-1水平,计算TF/TFPI-2比值。结果共纳入176例患者,ACS组96例,SAP组50例及正常组30例。各组间年龄,性别构成,高血压、吸烟、糖尿病构成比,低密度脂蛋白胆固醇、三酰甘油水平,他汀类药物及血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂使用率的差异均无统计学意义(P值均>0.05),ACS组的高密度脂蛋白胆固醇、左心室射血分数(LVEF)均显著低于SAP组和正常组(P值均<0.05),而血肌酐(sCr)、超敏C反应蛋白(hsCRP)均显著高于SAP组和正常组(P值均<0.05)。发病24h时,与SAP组和正常组相比,ACS组的TFPI-2水平显著降低(P值均<0.05),而TF、MMP-1水平及TF/TFPI-2比值均显著升高(P值均<0.05)。ACS组中,TF水平随病程的延长而逐步降低(P值均<0.05),TFPI-2水平随病程的延长而先升高,然后降低(P值均<0.05)。Logistic多元回归分析显示,血浆TFPI-2和LVEF下降以及血浆TF、MMP-1和hsCRP水平升高与ACS的发病相关(P值均<0.05)。结论老年ACS患者在病程早期的血浆TFPI-2水平较低,而TF、MMP-1水平较高,提示TFPI-2的分泌不足可能参与ACS的发病。
Objective To observe the changes of plasma tissue factor (TF), matrix metalloproteinase (MMP) -1 and TFPI-2 in the elderly patients with acute coronary syndrome (ACS) -2 in the pathogenesis of ACS and its significance. Methods The patients were hospitalized in Huashan and East China Hospital affiliated to Fudan University from March 2008 to March 2009 and were enrolled in ACS group and SAP group according to clinical manifestations and coronary angiography results respectively . Coronary angiography normal elderly healthy subjects were selected normal group. Peripheral venous blood was collected in ACS group within 24h after admission and 2,4 weeks after onset, and peripheral venous blood was collected within 24 hours after admission in SAP group. Plasma TF, TFPI-2 and MMP-1 levels were detected by enzyme-linked immunosorbent assay , Calculate TF / TFPI-2 ratio. Results A total of 176 patients were enrolled, 96 patients in the ACS group, 50 patients in the SAP group and 30 patients in the normal group. Age, sex composition, hypertension, smoking, constitutional ratio of diabetes, LDL-C, triglyceride, statins and angiotensin converting enzyme inhibitor / angiotensin II receptor antagonist (P> 0.05). The levels of high density lipoprotein cholesterol and left ventricular ejection fraction (LVEF) in ACS group were significantly lower than those in SAP group and normal group (P <0.05), but not in SAP group Serum creatinine (sCr) and high sensitivity C-reactive protein (hsCRP) were significantly higher than the SAP group and normal group (P <0.05). At 24 hours of onset, TFPI-2 levels in ACS group were significantly lower than those in SAP group and normal group (all P <0.05), and the ratios of TF, MMP-1 and TF / TFPI- All <0.05). In ACS group, the level of TF gradually decreased with the prolongation of the course of disease (all P <0.05). The level of TFPI-2 increased first and then decreased with the prolongation of the course (P <0.05). Logistic multivariate regression analysis showed that the decrease of plasma TFPI-2 and LVEF, and the increase of plasma TF, MMP-1 and hsCRP levels were associated with the incidence of ACS (all P <0.05). Conclusions Plasma TFPI-2 levels are lower in elderly patients with ACS but higher in TF and MMP-1, suggesting that TFPI-2 may be involved in the pathogenesis of ACS.