【作者】 董巧玲；

【导师】 刘俊；

【作者基本信息】 大连医科大学 ， 内科学， 2006， 硕士

【摘要】 背景：弹性蛋白溶解的半胱氨酸蛋白酶、天冬氨酸蛋白酶等组织蛋白酶的过度表达，参与动脉粥样硬化的形成。蛋白酶溶解活性和抗蛋白酶溶解活性比例失衡在血管壁重建和动脉粥样硬化斑块稳定性中发挥重要作用。在血清中Cystatin C是最丰富的蛋白酶抑制剂。有研究发现，在主动脉瘤患者血清Cystatin C水平较低，且通过超声探测发现早期动脉瘤患者血清Cystatin C水平与动脉瘤病变扩展呈负相关。也有研究发现在动脉粥样硬化和动脉瘤病变组织中Cystatin C表达明显低下。 目的：探讨血清Cystatin C在急性心肌梗死病人发病不同时期的浓度变化及作为早期诊断指标和预测斑块稳定性的临床价值。 方法：采用速率散射比浊法对发病48小时内及1周后的急性心肌梗死病人、不稳定心绞痛患者和对照组的血清Cystatin C水平进行测定。 结果：血清Cystatin C在急性心肌梗死组发病48小时内与对照组相比有所下降，但没有达到统计学意义(P=0.28)。然而当用肌酐校正后即Cystatin C／Creatinine进行计算时，差别明显，达到统计学意义(P=0.003)。同一组急性心肌梗死患者在发病1周后与发病48小时内相比，血清Cystatin C水平明显升高(P=0.04)。在直线相关分析中，血清Cystatin C水平与年龄、肌酐呈正相关。在多元逐步回归分析时，年龄与肌酐仍与血清Cystatin C水平独立相关，Multiple R=0.413。 结论：血清Cystatin C水平在急性心肌梗死发病早期明显下降。是否血清Cystatin C水平的下降先于急性心肌梗死发病已经存在，且能触发冠状动脉粥样斑块的破裂，或是血清Cystatin C水平的下降仅代表一种负向的急性期反应，目前仍然不清楚。提示血清Cystatin C浓度变化在一定程度上可作为急性心肌梗死早期诊断的参考指标。更多还原

【Abstract】 Background: Overexpression of elastolytic cysteine and aspartic proteases, known as cathepsins, is implicated in atherogenesis. Imbalance of proteolytic and antiproteolytic levels plays a important role in vascular wall remodeling and the stability of the atherosclerosis plaque. Cystatin C is the most abundant protease inhibitor in the plasma. Low plasma levels have been found in patients’ with aortic aneurysms and they seem correlated with the extension of the aortic lesions in early aneurysms detected by ultrasonography. Low intralesion Cystatin C expression have also been found in patients with established aortic aneurysm and atherosclerosis.Objective: To explore the changes of serum Cystatin C and its value as a sign of early diagnosis and predicting stability of atherosclerotic plaque in patients with acute myocardial infarction.Methods: In this study, serum levels of Cystatin C have been investigated in patients with acute myocardial infarction, unstable angina and controls.Results: Cystatin C was lower in acute myocardial infarction (AMI) patients during onset but the difference did not reach statistical significance compared to controls(P=0.28). Nevertheless, when Cystatin C/Creatinine ratio was considered, significantly lower values were found in acute AMI patients(P=0.003). Cystatin C plasma levels increased in the same AMI patients in a week after the acute event(P=0.04). At univariate analyses, Cystatin C levels were positively correlated with age and creatinine. The same variables were also independently correlated with Cystatin C levels in a multiple-regression analysis with a multiple R=0.413.更多还原