【作者】 苏健康；

【导师】 党瑜华；

【作者基本信息】 郑州大学 ， 内科学， 2010， 硕士

【摘要】 背景：随着对动脉粥样硬化发病机制的深入研究,炎症机制越来越引起重视。内脏脂泌素(visfatin)是最近发现的一种主要有内脏脂肪细胞分泌的的细胞因子,与糖尿病、肥胖、胰岛素抗体、和心血管疾病关系密切。最新的研究结果表明内脏脂泌素被证明是一种新的炎症介质,可能参与冠心病的发生发展,并在斑块不稳定状态中起重要作用。本研究对冠心病患者血浆内脏脂泌素水平进行检测,旨在探讨内脏脂泌素与冠心病的关系。目的：本研究主要观察血浆内脏脂泌素水平在不同类型冠心病患者血浆的变化,并与胰岛素抵抗指数(IRI),肿瘤坏死因子α(TNF-α)及血脂相比较,以探讨其与冠心病的关系。方法：选取郑州大学第一附属医院心内科2008年11月至2009年4月住院患者88例。经冠状动脉造影检查确诊为冠心病患者73例,其中稳定性心绞痛(SAP)30例,男18例,女12例,年龄40-79岁,平均(60.4±9.0)岁,不稳定心绞痛(UAP)23例,男14例,女9例,年龄40-75岁,平均(60.4±9.5)岁,急性心肌梗死(AMI)20例,男11例,女9例,年龄45-75岁,平均(60.4±7.3)岁,对照组15例,均为同期住院经冠脉造影后排除冠心病患者,男8例,女7例,年龄46-74岁,平均(58.1±7.4)岁。入院次晨空腹(AMI者在发病48小时以内)采静脉血,常规检测空腹血糖(FPG)及甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C),同时留血浆-80℃保存,待测空腹血浆visfatin、胰岛素及TNF-α。结果：①与正常对照组(15.91±4.23)ng/L相比,visfatin水平在稳定型心绞痛组(36.68±7.42)ng/L,不稳定心绞痛组(53.15±8.34)ng/L,急性心肌梗死组(72.55±7.21)ng/L均升高(p均<0.05)。TNF-α在稳定型心绞痛组(17.04±3.27)ng/L,不稳定心绞痛组(53.83±8.66)ng/L,急性心肌梗死组(73.72±12.84)ng/L,均高于正常对照组(11.17±2.58)ng/L(p均<0.05)。IRI在稳定型心绞痛组(5.63±1.71),不稳定心绞痛组(9.24±2.64),急性心肌梗死组(9.10±1.56),均高于正常对照组(2.27±0.64)(p均<0.05)。②相关分析显示脂泌素与TNF-α、IRI及LDL-C成正相关,r值分别为0.842、0.732、0.351,p<0.05,与HDL-C成负相关,r值为-0.400,p<0.05。结论：1.血浆脂泌素、TNF-α及IRI在CHD组明显高于对照组,提示血浆脂泌素、TNF-α及IR可能参与了冠心病的发生发展。2.血浆脂泌素、TNF-α及IRI在AMI组和UAP组高于SAP组,提示血浆脂泌素、TNF-α及IR可能与冠状动脉粥样斑块不稳定有关。3.脂泌素与炎症标志物TNF-α相关性分析显示呈正相关,提示脂泌素可能作为炎症因子在冠心病发生发展中起作用。4.脂泌素与IRI在冠心病患者中呈正相关,提示脂泌素与IR均可能影响冠心病发生发展。5.脂泌素与LDL成正相关,与HDL成负相关,表明脂泌素与血脂代谢异常有关。更多还原

【Abstract】 Background:As atherosclerosis is continuously researched, the inflammation mechanism is paid more attention. Visfatin is a recently discovered another new fat cell factor, it was secreted from visceral fat cell. The latest research results show that visfatin may be related to diabetes, obesity, insulin antibodies,and cardiovascular disease.The research results show that visfatin was proved to be a new inflammatory mediators may be play an important role in occurrence and development of coronary heart disease and lead to plaque vulnerability. The purpose of the study is to observe the changes of plasm visfatin level in patients with coronary heart disease, to explore the relationship between visfatin and coronary heart disease.Aim:The aim of the study is to observe the changes of plasm visfatin level in different types of patients with coronary heart disease,and compared with the levels of tumor necrosis factor-a(TNF-a) and insulin resistance index(IRI).In order to explore the relationship between visfatin and coronary heart disease.Methods:A total number of 88 in-patients who received coronary angiography in our hospital,from November 2008 to April 2009,73 patients was confirmed by coronary angiography with coronary heart disease (CHD); the coronary artery is normal for the control group in coronary angiography; CHD were divided into three groups: stable angina pectoris (SAP) group (n=30), unstable angina pectoris (UAP) group (n=23), acute myocardial infarction (AMI) group (n=20). The next morning or immediately after hospitalization,fasting venous blood of patients were collected, puting into natrium citricum anticoagulant tube,3500 r/min centrifuge for 5 min in 2 h, collecting plasm 200μL put into Ep tube storing in-80℃refrigeratory. The fasting plasma visfatin,TNF-a and insulin were examined by ELISA, and related parameters lipids were measured (cardiac muscle enzyme and CTnT were measured in UAP and AMI)Result:①Compared with normal control, visfatin levels [(15.91±4.23) ng/L,in normal control] were elevated in patients with SAP [(36.68±7.42) ng/L], in patients with UAP [(53.15±8.34)ng/L], and in patients with AMI [(72.55±7.21)ng/L],(allp<0.05). TNF-a levels were (17.04±3.27) ng/L in SAP, (53.83±8.66) ng/L in UAP, (73.72±12.84) ng/L in AMI, higher than the normal control group (11.17±2.58) ng/L, (allp<0.05). IRI levels were (5.63±1.71) in SAP, (9.24±2.64) in UAP, (9.10±1.56) in AMI, higher than the control group (2.27±0.64), (all p<0.05. Correlated analysis demonstrated that the fasting plasma visfatin levels was positively correlated with the levels of TNF-a, IRI and low densith lipoprotein cholesterol (LDL-C),(r:0.842、0.732、0.351, respectively, all p<0.05); but it was negatively correlated with high-density lipoprotein cholesterol (HDL-C), (r:-0.400, respectively, p<0.05).Conclusion:1. Plasma levels of visfatin, TNF-a and IRI in CHD group was significantly higher than that in the control group.It suggested that visfatin, TNF-a and IR play an important role in the development of CHD.2. Plasma levels of visfatin, TNF-a and IRI in AMI group and UAP group was significantly higher than that in the SAP group.It suggested that visfatin, TNF-a and IR all related with the instability of plaques.3. Visfatin and TNF-a was positive correlated.It suggested that visfatin may be used as inflammatory factors and play a important role in the development of CHD.4. In CHD patients, visfatin and IRI were positive correlated.It suggested that visfatin and IR may affect the development of coronary heart disease.5. In CHD patients,visfatin and LDL-C was positive correlated,and with HDL-C was negatively correlated.It indicated that visfatin in relation to lipid metabolic abnormalities.更多还原