【作者】 李莉；

【导师】 牛楠；

【作者基本信息】 大连医科大学 ， 内科学， 2016， 硕士

【摘要】 目的:探讨冠心病患者血清半乳糖凝集素-3(Galectin-3)的表达水平和瑞舒伐他汀对其干预作用。方法:选择2015年09月至2016年1月期间在大连医科大学附属第二医医院心血管内科住院患者共114例,根据病史、心电图、实验室检查、冠状动脉CT、冠状动脉造影检查等综合结果将研究对象分成3组:包括对照组(CON)36例、稳定型心绞痛(SAP)组16例、急性冠脉综合征(ACS)组62例。根据冠状动脉造影结果将冠心病患者进行Gensini评分并分为非严重病变组(Gensini评分≤30分,共36例)及严重病变组(Gensini评分>30分,共42例)。比较血清Gal-3、HS-CRP水平在各组间差异。急性冠脉综合征患者随机分为瑞舒伐他汀10mg治疗组和瑞舒伐他汀20mg两组,随诊1个月比较治疗前后Gal-3水平差异。急性心肌梗死患者分别于发病6小时、12小时、24小时、72小时、1周测定Gal-3水平及CTNI水平,探究胸痛发作后其动态水平变化。采集入院患者的基本临床资料,使用美国贝克曼LX20全自动分析仪测定超敏C反应蛋白(hs-CRP),酶联免疫吸附法(ELISA)测定血清Galectin-3水平。采用SPSS17.0统计软件进行数据的分析处理。结果:1、Gal-3及hs-CRP在对照组、稳定性心绞痛组和急性冠脉综合征组之间差异有统计学意义(P<0.05),其水平值依次为对照组<稳定性心绞痛组<急性冠脉综合征组;冠脉严重病变组的血清Gal-3及hs-CRP水平高于非严重病变组(P<0.05);2、冠心病患者Gal-3水平值与hs-CRP、Gensini评分呈明显正相关(P<0.05);3、Logistic回归分析冠心病传统危险因素和血清Gal-3水平,高水平Gal-3是急性冠脉综合征的独立危险因素;4、急性冠脉综合征(ACS)患者瑞舒伐他汀治疗后Gal-3水平较治疗前明显降低(P<0.05),瑞舒伐他汀20mg治疗组降低Gal-3水平幅度明显大于瑞舒伐他汀10mg治疗组(P<0.05);5、通过重复测量方差分析急性心肌梗死患者6h、12h、24h、72h、1周的CTNI及Gal-3水平,CTNI存在动态水平变化(P<0.05),血清Gal-3水平在发病6h至发病1周时间内无明显动态变化。结论:1、冠心病患者Gal-3表达水平可以作为判断冠心病病情及冠脉病变严重程度的参考指标,急性心肌梗死患者发病1周时间内Gal-3无明显动态变化;2、瑞舒伐他汀降低冠心病患者Gal-3表达水平,推测其可能通过抑制Gal-3起到稳定斑块作用。更多还原

【Abstract】 Objective: The aim of this study is to determine the relationship between serum galectin-3(Gal-3)levels and the severity of coronary artery disease(CAD).The effects of rosuvastatin on galectin-3 in patients with acute coronary syndrome is also studied.Methods: 114 observation subjects were from the Second Affiliated Hospital of Dalian Medical University during September 2015 to January 2016.The study subjects were divided into 3 groups according to medical history,electrocardiogram,laboratory examination,coronary artery CT,coronary angiography and other comprehensive results.The study groups were composed of 62 patients with acute coronary syndrome(ACS)and 16 patients with stable angina pactoris(SAP).The control group was composed of 36 healthy individuals.According to the Gensini score,the patients with coronary artery disease(CAD)were divided into severe disease group(Gensini>30,n=42)and non-severe disease group(Gensini≤30,n=42).Serum Gal-3,hs-CRP were compared.Patients with CAD were randomly given 10 mg rosuvastatin or 20 mg rosuvastatin treatment for one month.Gal-3 after treatment with rosuvastatin were compared with that before treatment.Venous blood in patients with acute myocardial infarction at the sixth hour,twelfth hour,twenty-fourth hour,seventy-second hour and first week were collected for Gal-3 and CTNI measurement.The basic clinical data of patients was collected.High sensitive C reactive protein(hs-CRP)was measured using the American Backman LX20 automatic analyzer.Galectin-3 was measured using ELISA(enzyme-linked immune sorbent assay).SPSS 17.0 was used for statistical analysis.Results: 1.Galectin-3 in patients with ACS was significantly higher than that in patients with SAP(62.02±12.22 vs 48.31±4.89pg/ml,p<0.05).Serum galectin-3 levels were higher in the patients with SAP than that in the control group(48.31±4.89 vs 31.74±2.74pg/m L,p<0.05).Serum galectin-3 and hs-CRP in patients with severe stenosis were higher than that in non-serious disease group(P < 0.05).2.In the correlation analysis,Gal-3 had significant correlation with the Gensini score(r=0.505,P<0.05)and hs-CRP(r=0.417,P<0.05).3.Logistic regression analysis of the traditional risk factors of coronary artery disease and serum Gal-3 level,higher Gal-3 is an independent risk factor for acute coronary syndrome.4.After one month treatment with rosuvastatin,Gal-3 in patients with CAD was significantly reduced(P<0.05);the reduction of Gal-3 with 20 mg rosuvastatin treatment is much greater than that with 10mg(P<0.05).5.Serum galectin-3 and CTNI in patients with acute myocardial infarction at the sixth hour,twelfth hour,twenty-fourth hour,seventy-second hour and first week were analysed;CTNI had a dynamic change;Galectin-3 has no change in the acute myocardial infarction within one week.Conclusion:1.Gal-3 may be used as a reference index for the severity of coronary artery disease and stenosis degree of coronary artery lesion;But there was no change in the acute myocardial infarction within one week.2.Rosuvastatin may stabilize the plaque by lowering Gal-3.更多还原