【作者】 王鹏；

【导师】 赵延恕；

【作者基本信息】 中南大学 ， 临床医学， 2013， 硕士

【摘要】 目的：通过分析血清脂联素(APN)、基质金属蛋白酶-9(MMP-9)在冠心病形成过程中的作用以及二者的相关性,探讨联合检测两种炎性因子在识别冠心病高危患者及急性冠脉综合征(ACS)的早期诊治中的临床意义。方法：随机收集湘雅二医院心血管内科病房2012年5月至2013年1月住院治疗并经冠状动脉造影证实的冠心病患者(至少有一支血管狭窄程度≥50%)共70例作为实验组。根据冠心病类型分为稳定性心绞痛(SA)组22例,不稳定性心绞痛(UA)组24例,急性心肌梗死(AMI)组24例；根据冠脉造影结果将患者分为单支病变组23例、双支病变组25例、三支病变组22例。并收集20例年龄、性别与实验组相匹配的湘雅二医院同期冠脉造影正常的非冠心病患者作为对照组。记录所有研究对象的基本资料。使用专用电脑软件进行冠脉Gensini评分。采用酶联免疫吸附法测定血清APN, MMP-9浓度。结果：1、冠心病各组血清APN水平均低于正常对照组(P<0.05),UA组及AMI组低于SA组(P<0.05),AMI组低于UA组(P<0.05),血清APN与冠心病各组Gensini积分均呈负相关(P<0.05)；2、冠心病各组血清MMP-9水平均明显高于正常对照组(P<0.05),UA组及AMI组高于SA组(P<0.05), AMI组高于UA组(P<0.05),血清MMP-9水平与冠心病各组Gensini积分均呈正相关(P<0.05)；3、三支病变组血清APN水平低于双支病变组(P<0.05),双支病变组低于单支病变组(P<0.05),单支病变组低于对照组(P<0.05)；4、三支病变组血清MMP-9水平高于双支病变组(P<0.05),双支病变组高于单支病变组(P<0.05),单支病变组高于对照组(P<0.05)；5、血清APN与MMP-9水平呈负相关(P<0.05)。结论：1、冠心病患者血清APN水平降低,且APN水平与冠心病病变程度呈负相关。2、冠心病患者血清MMP-9水平升高,且MMP-9水平与冠心病病变程度呈正相关。3、APN与MMP-9水平呈负相关,联合检测APN和MMP-9可能对于判断冠心病严重程度及ACS的早期预测具有重要的临床意义。更多还原

【Abstract】 Objective：To investigate the value of detecting the two inflammatory factors together in the identification of high-risk patients with coronary heart disease(CHD) and early diagnosis of acute coronary syndrome (ACS) through analysing the correlation between serum adiponectin (APN) and matrix metalloproteinase-9(MMP-9) in the CHD.Methods:A total of70patients who were diagnosed with CHD(at least one major coronary artery≥50%) by means of coronary angiography admitted into the Second Xiangya Hospital from May,2012to Jan,2013were recruited.Patients were divided into three groups according to classification of CHD:SA group(22cases),UA group(24cases),AMI group(24cases); patients were divided into single-vessel disease group (23cases), double-vessels disease group (25cases), three-vessels disease group (22cases)according to the results of coronary angiography.20cases without CHD by means of coronary angiography comprised the control group.All the cases’general data were collected. The coronary gensini score was calculated by using special computer software.Serum APN and MMP-9were measured using an enzyme-linked immunosorbent assay (ELISA). Results:1、 The serum APN levels in the three groups with CHD were all significantly lower than those in the control group (P<0.05),the serum APN levels in the UA group and AMI group were significantly lower than those in the SA group (P<0.05), the serum APN levels in the AMI group were significantly lower than thoes in the UA group (P<0.05), the serum APN level was negatively correlated with the coronary gensini score in each group with CHD(P<0.05).2、The serum MMP-9levels in the three groups with CHD were all significantly higher than those in the control group (P<0.05),the serum MMP-9levels in the UA group and AMI group were significantly higher than those in the SA group (P<0.05), the serum MMP-9levels in the AMI group were significantly higher than thoes in the UA group (P<0.05), the serum MMP-9level was positively correlated with the coronary gensini score in each group with CHD(P<0.05);3、The serum APN levels in the three-vessel disease group were lower than those in the double-vessel disease group (P<0.05), the serum APN levels in the double-vessel disease group were lower than those in the single-vessel disease group (P<0.05), the serum APN levels in the single-vessel disease group were lower than those in the control group (P <0.05).4、The serum MMP-9levels in the three-vessel disease group were higher than those in the double-vessel disease group (P<0.05), the serum MMP-9levels in the double-vessel disease group were higher than those in the single-vessel disease group (P<0.05), the serum MMP-9levels in the single-vessel disease group were higher than those in the control group (P<0.05)5、 The serum APN level was negatively correlated with the MMP-9level in the CHD(P<0.05).Conclusions:1、The serum APN levels in patients with CHD were reduced, and the serum APN level was correlated negatively with the severity of CHD.2、The serum MMP-9levels in patients with CHD were increased, and the serum MMP-9level was correlated positively with the severity of CHD.3、The serum APN level was negatively correlated with the MMP-9level in the CHD;here may be a predictive value for the severity of CHD and the occurrence of ACS by detecting APN and MMP-9together.更多还原