本文關鍵詞：急性冠脈綜合征患者血清高遷移率族蛋白B1的表達及PCI圍術期強化阿托伐他汀干預治療的影響　出處：《天津醫(yī)科大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 急性冠脈綜合征血管成形術 經腔 經皮冠狀動脈 高遷移率族蛋白B1 基質金屬蛋白酶-9 C反應蛋白 阿托伐他汀

【摘要】：目的觀察血清高遷移率族蛋白B1(HMGB1)、超敏C反應蛋白(hs-CRP)及基質金屬蛋白酶-9(MMP-9)在急性冠脈綜合征(ACS)患者中的表達,探討其與ACS的關系;探討圍手術期強化阿托伐他汀干預治療對ACS患者經皮冠狀動脈介入治療(PCI)術后HMGB1、hs-CRP及MMP-9的影響及其臨床意義。方法1、連續(xù)選取在2014年5月到2015年5月期間因急性胸痛入住天津市胸科醫(yī)院,行冠狀動脈造影(CAG)后確診為ACS,并同時行首次PCI治療的患者120例;另選取同時段就診于我院并經CAG檢查除外冠心病(CHD)的患者106例,作為對照組。全部入組患者均于介入術前采取空腹肘靜脈血,檢測血清HMGB1、hs-CRP及MMP-9水平,并利用全自動生化分析儀分析血脂、同型半胱氨酸(HCY)及氨基末端腦鈉尿肽原(NT-proBNP)等生化指標。依據患者冠脈病變的支數(shù)將ACS患者分為3組:單支冠脈病變組(44例),雙支冠脈病變組(40例)及三支冠脈病變組(36例),分析血清HMGB1、hs-CRP及MMP-9水平在各組間的水平差異;采取Logistic回歸分析法分析ACS的危險因素,并探討ACS患者血清HMGB1水平與hs-CRP、MMP-9水平以及其他ACS危險因素間的相關關系。2、按照隨機數(shù)字表法將ACS組患者分為兩組,即標準組(60例)和強化組(60例),PCI術前分別給予兩組患者阿托伐他汀鈣片20mg頓服和40mg頓服治療,術后分別繼續(xù)予以阿托伐他汀鈣片20mg每天1次和40mg每天1次治療,并于PCI術后24h、1周再次采取空腹肘靜脈血,用ELISA法分析HMGB1、hs-CRP及MMP-9水平;并于PCI術前及術后1月行心臟超聲檢測ACS患者左心室舒張末期內徑(LVEDD)及左室射血分數(shù)(LVEF),并于PCI術后1個月復查氨基末端腦鈉尿肽原(NT-proBNP);隨訪6個月觀察這期間兩組ACS患者主要不良心臟事件(MACE)的發(fā)生情況。結果1、ACS組患者血清HMGB1、hs-CRP、MMP-9及NT-proBNP水平均顯著高于對照組患者,差異有統(tǒng)計學意義(均P0.05);且冠脈病變程度加重,血清HMGB1、hs-CRP、MMP-9水平也隨之升高(均P0.05)。2、相關性分析結果顯示,HMGB1水平、hs-CRP水平與ACS呈正相關關系,高密度脂蛋白膽固醇(HDL-C)與ACS呈負相關關系(均P0.05);且ACS組患者血清HMBG1水平與hs-CRP水平呈正相關關系(γ=0.300,P0.05)。3、PCI術前,標準組與強化組患者血清HMGB1、hs-CRP及MMP-9水平差異無統(tǒng)計學意義(P0.05)。術后24h,兩組患者血清HMGB1、hs-CRP及MMP-9水平均較術前明顯升高,差異有統(tǒng)計學意義(均P0.05);但兩組患者間無明顯差異(P0.05)。術后1周,標準組與強化組患者血清HMGB1、hs-CRP及MMP-9水平均較術后24h降低,且強化組下降更顯著(均P0.05),與術前相比,標準組患者上述炎癥因子水平仍顯著升高(均P0.05),但強化組患者升高已不明顯,差異無統(tǒng)計學意義(均P0.05)。4、與PCI術前相比,術后1個月,標準組與強化組患者的LVEDD及NT-proBNP水平均較術前降低,LVEF較術前升高(均P0.05),但兩組間差異無統(tǒng)計學意義(均P0.05);截止到隨訪結束(PCI術后6個月),強化組及標準組患者發(fā)生主要不良心臟事件(MACE)的患者總數(shù)分別為:3例和8例,差異有統(tǒng)計學意義(P0.05)。結論1、ACS患者的血清HMGB1的水平顯著升高,而且與ACS呈正相關,它可能是ACS的一種危險因素。HMGB1與hs-CRP相互影響,在動脈粥樣硬化和ACS的發(fā)病機制中發(fā)揮著重要作用。2、早期應用強化阿托伐他汀鈣片治療更能顯著降低PCI術后急性期ACS患者HMGB1的表達,減輕ACS患者急性期的炎癥反應,穩(wěn)定冠脈粥樣硬化斑塊,改善其心功能及短期預后,且其短期內的安全性良好。
[Abstract]:Objective To observe the serum high mobility group protein B1 (HMGB1), high sensitive C reactive protein (hs-CRP) and matrix metalloproteinase -9 (MMP-9) in patients with acute coronary syndrome (ACS) patients, and explore its relationship with ACS; to evaluate the perioperative intensive atorvastatin therapy on the treatment of percutaneous coronary intervention arterial intervention in patients with ACS (PCI) after HMGB1, hs-CRP and MMP-9 and its clinical significance. Methods 1, continuous selection in May 2014 to May 2015 in Tianjin Thoracic Hospital due to acute chest pain, coronary artery angiography (CAG) were diagnosed as ACS, and for the first time in 120 cases of patients treated with PCI were selected at the same time to visit; in our hospital and examined by CAG except for coronary heart disease (CHD) in 106 cases of patients, as control group. All patients in the preoperative intervention take fasting venous blood, serum HMGB1, hs-CRP and MMP-9 level, and the use of automatic biochemical analyzer Analysis of blood lipid, homocysteine (HCY) and N-terminal pro brain natriuretic peptide (NT-proBNP) and other biochemical indicators. On the basis of coronary artery lesions in patients with the number of ACS patients were divided into 3 groups: single vessel coronary artery disease group (44 cases), double vessel coronary disease group (40 cases) and coronary artery lesion group (three 36 cases), analysis of serum HMGB1, hs-CRP level and MMP-9 level in the differences between groups were taken; Logistic regression analysis of risk factors of ACS analysis method, and to investigate the levels of serum HMGB1 in patients with ACS and hs-CRP, MMP-9 and other ACS risk factors and the correlation between.2, according to the random number table method were divided into ACS group into two groups, namely the standard group (60 cases) and intensive group (60 cases), preoperative PCI were treated with two groups of Atorvastatin Calcium Tablets 20mg and 40mg meal meal treatment respectively, continue to be the Atorvastatin Calcium Tablets 20mg 1 times a day and 40mg 1 times a day after treatment, PCI and 24h after operation, 1 weeks again Take the venous blood, HMGB1 analysis using ELISA method, hs-CRP and MMP-9; and in January for cardiac ultrasound detection of ACS in patients with left ventricular end diastolic diameter PCI before and after surgery (LVEDD) and left ventricular ejection fraction (LVEF), and PCI 1 months after the treatment, N-terminal brain natriuretic peptide (NT-proBNP); after 6 months of follow-up observation of the two groups during ACS in patients with major adverse cardiac events (MACE). The incidence of the 1 groups of patients with ACS, HMGB1, hs-CRP, MMP-9 and NT-proBNP were significantly higher than those in control group, the difference was statistically significant (P0.05); and the severity of coronary lesion serum HMGB1, hs-CRP, MMP-9, along with elevated levels of.2 (P0.05), correlation analysis showed that the HMGB1 level, hs-CRP level was positively correlated with ACS, high density lipoprotein cholesterol (HDL-C) was negatively correlated with ACS (P0.05); and group ACS serum level of HMBG1 and hs-CRP in water 騫沖憟姝ｇ浉鍏沖叧緋，

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