血浆脂联素水平与冠脉病变及PWV、ABI的关系研究

1、血浆脂联素水平与冠脉病变及PWV、ABI的关系研究作者：刘伯芹，安 毅，曹广智，许丰强 作者单位：青岛大学医学院附属医院心内科，山东青岛【摘要】 目的 观察冠心病(CHD)患者血浆脂联素(APN)水平，踝臂指数(ABI)和脉搏波传导速度(PWV)并探讨它们与冠脉病变之间的关系。方法 选取在本院心内科行冠脉造影的住院病人98例，53例诊断为急性冠脉综合征(ACS)，22例诊断为稳定性心绞痛(SAP);23例冠脉造影正常者为对照组;采用酶联免疫法检测APN水平，动脉硬化检测仪检测ABI，PWV。结果 ACS组APN水平低于正常对照组(P0.01)低与SAP组(P0.05)，经冠脉造影证实的冠心病组

2、APN低于正常对照组(P0.01)，其中三支病变组血浆脂联素水平低于单支及双支病变组，均有统计学意义;APN越低，PWV值越大，ABI水平越低。结论 CHD病人血浆APN水平明显降低，APN的降低与冠脉狭窄程度,冠脉斑块的稳定性有密切关系。APN可能是冠心病的一个新的独立危险因子，它与ABI、PWV联合在评估冠心病患者冠脉病变程度及危险性方面具有重要意义。【关键词】 脂联素;急性冠脉综合征;稳定性心绞痛;踝臂指数;脉搏波传导速度The Relationship between Plasma Adiponectin Concentration and Pulse Wave Velocity、 A

3、nkle Brachial Index、the Severity of Coronary Artery Lesion in Coronary Heart Disease. LIU Bo_qin, AN Yi, CAO Guang_zhi, et al. Department of Cardiology, the Affiliated Hospital of Medical College, Qingdao University, Shandong 266061, ChinaAbstract Objective To explore the relationship between plasma

4、 adiponectin concentration(APN) and the ankle brachial index(ABI) 、the pulse wave velocity (PWV), the severity of coronary artery lesion in coronary heart disease (CHD). Methods A total of 98 subjects who attended the cardiovascular department of the affiliated hospital of Qingdao university medical

5、 college from Aug 2007 to Jun 2008 were enrolled. The subjects were divided into normal control group (n=23)、ACS group(acute coronary syndrome, n=53) and SAP group(stable angina pectoris, n=22) by angiography. Serum APN concentration was evaluated by ELISA system, ABI and PWV were tested by the non_

6、invasive vascular screening device. Results APN was significantly lower in ACS group than that in control group(P0.01) and SAP group(P0.05). Compared to control group, APN was significantly lower in CHD group (P0.01). APN was significantly lower in patients with three vascular lesions than that in t

7、he control group and in those with one vascular lesion (P0.05). There was no difference in APN between three vascular lesions and two vascular lesions. PWV was higher in CHD group than in control group(P0.05), and PWV was higher in those cases with three vascular lesions than in control group and in

8、 those with one vascular lesion (P0.01). ABI was higher in those cases with three vascular lesions than in control group (P0.05). Conclusions The plasma APN level is significantly lower in patients with CHD. The plasma APN level has close relationship with the severity of coronary artery stenosis, t

9、he stability of atherosclerotic plaque. APN might be as a new risk factor of CHD, and APN combined with ABI and PWV could provide a new and convenient way for revaluating and diagnosing the severity of coronary artery disease.Key words Adiponectin(APN); Acute coronary syndrome(ACS); Stable angina pe

10、ctoris(SAP); Ankle brachial index(ABI); Pulse wave velocity(PWV);本文旨在分析已行冠脉造影的三组患者的临床资料，定量检测患者的血浆脂联素水平，测定患者ABI及PWV，分析三者与冠状动脉病变严重程度的关系，探讨APN水平，ABI及PWV联合对该类患者心血管危险性的预测价值。1 资料与方法1.1 临床资料：选取2007年11月至2008年6月在青岛大学医学院附属医院心内科行冠脉造影的住院病人98例，其中53例诊断为ACS(择期行PCI)，男33例，女20例，平均年龄65.509.98岁;22例诊断为稳定性心绞痛，男12例，女10例，平

11、均年龄66.308.42岁;23例冠脉造影正常者为对照组，男12例，女11例，平均年龄62.4210.05岁，三组性别和年龄无统计学差异;诊断标准参照1979年国际心脏病学会及世界卫生组织关于缺血性心脏病的临床诊断标准。排除标准：原发性下肢动脉疾病如下肢动脉血栓形成，静脉炎等;严重肝肾功能不全者;急慢性感染性疾病、结缔组织病或肿瘤患者;最近两周未服用胰岛素增敏剂。1.2 方法1.3 统计学方法：全部数据用SPSS 12.0软件包，计量资料用x-s表示，APN的数据不符合正态分布，经对数转换后趋近正态分布。两组间比较用t检验,两组以上比较用方差分析，以P0.05为差异有统计学意义。2 结果2.1

12、 三组APN、ABI及PWV水平比较：见表1。表1 三组APN，ABI及PWV水平比较注：与对照组比较，*P0.01，*P0.05;与SAP组比较，#P0.052.2 不同冠脉病变APN、ABI及PWV水平比较：见表2。表2 不同冠脉病变患者APN、ABI及PWV水平比较注：与对照组比较，*P0.01，*P0.05;与单支病变比较，#P0.052.3 PWV各个值段的患者APN水平比较：见表3。表3 不同PWV患者APN水平比较 注：与PWV1400比较，*P0.05;与PWV=14001800比较，#P0.052.4 不同ABI值患者的APN水平比较：见表4。 表4 不同ABI患者APN水平

13、比较 注：与ABI=0.91.3比较，#P0.053 讨论本文结果显示冠心病两组APN水平显著低于对照组，其中ACS组与SAP组相比也有显著性差异，提示低脂联素血症是冠心病危险因素独立的预测指标1，且可预示动脉粥样硬化斑块的不稳定性2。根据冠脉造影结果只有三支病变组与健康对照组、一支病变组APN差异有统计学意义，三支病变组与双支病变组，双支病变组与一支病变组差异均无统计学意义。APN水平与冠心病严重程度相关，是否与经冠脉造影证实的冠脉病变支数对应相关?APN在冠心病发病机理中究竟起什么作用?尚需进一步的探讨。APN通过多种机制发挥着抗AS作用38，低脂联素血症患者容易发生AS，最终会导致CHD

14、，当发生ACS时，APN会聚集在破裂的斑块下，导致血浆APN水平迅速下降，因此ACS组APN水平显著低于健康对照组和SAP组。不同血管狭窄程度间APN水平的比较，病变程度越重，脂联素水平越低，但差异不显著，说明APN与血管平滑肌的增殖、迁移有关，但不是衡量血管狭窄程度的敏感指标。有研究提示动脉弹性与动脉粥样硬化有强相关性。Asmar等9对1470名原发性高血压患者的横断面研究也表明，PWV的升高与心血管病的存在具有显著相关性，这种相关性独立于抗高血压治疗而存在。动脉弹性减退僵硬度的增加是冠状动脉病变严重程度的预测因素10。本研究结果显示冠脉狭窄程度越重，PWV值越高，以PWV为1400或180

15、0为界限，随着PWV值的升高，脂联素水平逐渐降低，各组间差异有统计学意义。说明低脂联素血症可导致血管弹性的降低，其机理与血浆脂联素水平的降低导致抗平滑肌增殖，抗血管胶原纤维增殖作用降低有关。在冠心病诊断中PWV是一项方便快捷的检测指标。近年来随着对动脉硬化研究的深入，发现ABI与大动脉弹性，动脉粥样硬化狭窄的程度有良好的相关性。Papa_micheal等11研究了165名冠脉造影的患者，并对造影结果进行量化评分以评价冠状动脉病变的严重程度。结果显示：ABI0.9在冠脉造影正常、单支病变、双支病变三支病变患者中的比例分别为5%、11%、17%、30%，ABI0.9对于诊断多支病变的敏感性和特异性

16、24%和92%，ABI与冠状动脉病变的严重程度(评分Geenis评价)呈负相关(P=0.01)。本文结果显示ABI与冠脉狭窄程度有关，与斑块的稳定性无关，因此，ABI值在ACS组与SAP组差异不显著，在三支病变与正常对照组间差异有统计学意义，但未发现ABI值在三支病变与一支和两支病变间的显著性差异。如前所述APN既与冠脉狭窄程度有关又与冠脉冠脉斑块的稳定性有关，为进一步探讨ABI与APN的关系以ABI=0.9为界限，发现ABI0.9的患者，差异有统计学意义，说明二者作为衡量冠心病病变程度的指标其结果一致。应用APN和PWV、ABI联合评估冠脉血管损害，可早期检出高危患者，同时也为判断临床干预效

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