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老年急性冠脉综合征早期血浆组织因子及其途径抑制物2变化规律的临床研究

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DOI:
作者:
赵碧莲,刘鸿元,倪唤春, 罗心平, 李剑,金波,朱军,李延林, 沈伟,施海明
Zhao Bilian, Liu Hongyuan, Ni Huanchun, LuoXinping
作者单位:
复旦大学附属华山医院心内科 复旦大学附属华东医院心内科
Cardiac department, Huashan Hospital affiliated to Fudan University, Cardiac department, Huadong Hospital affiliated to Fudan University
关键词:
急性冠脉综合征； 组织因子途径抑制物2； 组织因子；基质金属蛋白酶
acute coronary syndrome; tissue factor; tissue factor pathway inhibitor-2；matrix metalloproteinase
摘要:
目的 研究老年急性冠脉综合征（ACS）患者早期血浆组织因子（TF）、基质金属蛋白酶（MMP-1）和组织因子途径抑制物2（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月至2009年3月间华山及华东医院年龄≥60岁的住院病人，按WHO标准诊断ACS及稳定型心绞痛（SAP），所有患者均经过冠状动脉造影证实诊断。将ACS组进一步细分为急性心梗组（AMI）及不稳定性心绞痛组（UAP）；设置SAP组及冠状动脉造影正常的老年组（Control）作为对照。由专人进行临床资料收集。ACS患者分别于入院24小时内、发病后2周、4周分别采集外周静脉血，对照组于入院24小时内采血， ELISA试剂盒检测血浆TF、TFPI-2及MMP-1水平，计算TF/TFPI-2比值，进行组间比较，并进行相关性分析；以ACS为因变量，对各变量进行Logistic多重回归分析。结果 共纳入96名ACS患者，50名SAP患者及30名造影阴性者。各组患者在年龄、性别、糖尿病、高血压、吸烟、低密度脂蛋白胆固醇、甘油三酯等方面并无显著差异，但ACS组的高密度脂蛋白胆固醇、左室射血分数较另外两组为低，而血清肌酐、高敏C反应蛋白较另两组为高。入院时ACS组血浆TF、MMP-1水平显著高于SAP组及对照组（P<0.05），而TFPI-2水平显著低于SAP组及对照组（P<0.05），TFPI-2与TF及MMP-1水平呈负相关。随病程延长ACS组TF的水平逐步降低，而TFPI-2的水平逐渐升高，差异有显著性（P<0.05）。结论 老年ACS患者早期血浆TFPI-2水平较SAP及Control组明显降低，而TF、MMP-1水平明显升高；提示TFPI-2的分泌不足可能参与ACS的发病，为ACS的干预提供新的思路。
Objective To observe the levels of changes plasma tissue factor(TF) , matrix metalloproteinase 1 (MMP-1)and tissue factor pathway inhibitor-2(TFPI-2) in elder patients with acute coronary syndrome(ACS) and to investigate the possibility of TFPI-2 as a early plasma markers for ACS in future. Methods Patients over 60 years old and admitted with possibility of coronary heart disease and received coronary angiogram were continuously enrolled in Huashan and Huadong Hospital during March 2008 to March 2009. Venous blood samples were obtained at 3 time points from all ACS patients: on admission (within 24 hours of symptom onset), after 2 weeks and after 4 weeks. Plasma concentrations of TF, TFPI-2 and MMP-1 were measured by commercial ELISA kits. Data was analyzed by SPSS 15.0. Results A total of 176 patients were enrolled, 96 with ACS, 50 with stable coronary disease and 30 with normal coronary arteries. There was no difference in age, gender, diabetes, hypertension, smoking, low density lipoprotein and triglyceride among three groups. High density lipoprotein and left ventricular ejection fraction levels were lower while serum creatinine and high sensitive C reactive protein levels were higher in ACS patients compared with SAP or control. On admission, plasma TF and MMP-1 levels were higher while plasma TFPI-2 levels were lower in ACS group than SAP or control group (P<0.05). Furthermore, there was a significant inverse correlation between TF (MMP-1) and TFPI-2 levels. As clinical course developed, plasma TF levels decreased and TFPI-2 levels elevated gradually (P<0.05). Conclusions ACS patients had lower plasma levels of TFPI-2 and higher levels of TF and MMP-1, implying lack of TFPI-2 and unbalance of plasma TF and TFPI-2 ratio may be related to ACS. It indicated that TF、TFPI-2 and ratio of TF to TFPI-2 might serve as important plasma indicators in early diagnosis of ACS.

 

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