【作者】 刘伯芹；

【导师】 安毅；

【作者基本信息】 青岛大学 ， 内科学， 2009， 硕士

【摘要】 目的血清脂联素(adiponectin,APN),一种脂肪组织来源的胶原样血浆蛋白,具有抗动脉粥样硬化,抗炎及改善胰岛素敏感性等作用;脉搏波传导速度(pulsewave velocity,PWV)指的是脉搏波在动脉的传导速度;ABI指的是上臂血压与脚踝血压的比值。本研究旨在观察冠心病(CHD)患者血浆脂联素(APN)水平,测量踝臂指数(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,尤其他们在冠心病诊断中的价值与意义。方法选取在本院心内科行冠脉造影的住院病人88例,43例诊断为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血浆APN水平,动脉硬化检测仪检测ABI,PWV。分别根据冠心病严重程度,冠脉造影结果,PWV值和ABI值进行分组,比较各组间APN,PWV,ABI的关系。结果1(1)APN水平:ACS组APN水平低于正常对照组(P＜0.01)及SAP组(P＜0.01),SAP组APN水平低于正常对照组(P＜0.01);(2)PWV水平:冠心病组高于正常对照组(P＜0.01),ACS组高于SAP组(P＜0.01)SAP组高于正常对照组(P＜0.01),差异有统计学意义;(3)ABI水平:ACS组低于正常对照组和SAP组(P＜0.01),SAP组与正常对照组相比差异无统计学意义。2(1)经冠脉造影证实的冠心病组APN水平低于正常对照组(P＜0.01),其中三支病变组APN水平低于健康对照组和单支病变组及双支病变组,差异有统计学意义;双支病变组血浆脂联素水平低于单支病变组(P＜0.05),差异有统计学意义。(2)ABI水平三支病变组ABI水平低于健康对照组,一支病变组(P＜0.01),低于双支病变组(P＜0.05);双支病变组低于健康对照组及单支病变组(P＜0.01);单支病变组与健康对照组间差异无统计学意义(P＞0.05)。(3)PWV水平,单支病变组与正常对照组差异五统计学意义(P＞0.05),其他各组间差异有统计学意义(P＜0.01)。3患者入院后测PWV值,其中＜1400cm/s,27人,1400cm/s～1800cm/s,32人,PWV＞1800cm/s,29人,比较PWV各个值段的患者APN水平。各组间差异均具有统计学意义(P＜0.01)。4比较不同ABI值患者的APN水平发现,以ABI=0.9为界,ABI＜0.9组患者APN水平低于ABI＞0.9组,PWV水平高于ABI＞0.9组,P＜0.01。结论(1)冠心病患者血浆APN水平明显降低,PWV升高,ABI降低;(2)冠心病患者血浆APN水平越低,PWV值越大,ABI水平也越低。(3)血浆APN水平的降低与冠脉狭窄程度,冠脉斑块的易损性有密切关系。APN可能是冠心病的一个新的独立危险因子,可作为冠心病情变化的标志之一(4)APN与ABI、PWV联合在冠心病的早期诊断,冠心病患者冠脉病变程度及危险性的评估及对冠心病患者预后方面的预测具有重要意义。(5)动态监测血清脂联素,PWV,ABI水平有可能成为早期诊断冠心病,观察病情,判断预后的一个指标。更多还原

【Abstract】 Objective Adiponectin(APN) is a kind of lipoaspiration-derived collagenase-like plasma protein,which could be anti-antiatherogenic,antiphlogistic and improve the sensibility of insulin.To investigate the variation of plasma adiponectin(APN),the ankle brachial index(ABI),and the pulse wave velocity(PWV) in patients with the coronary heart disease(CHD) and explore the correlation between them,especially the meaning and of those to the diagnosis of CHD.Methods A total of 98 subjects who attended the cardiovascular department of the affiliated hospital of Qingdao university medical college from Aug 2007 to Jun 2008 were enrolled.The subjects were divided into normal control group(n=23),the ACS group(n=43) and the SAP group(n=22) by angiography.Serum concentrations ’of adiponctin were evaluated by ELISA system,the the ABI and the PWV were tested by the non-invasive vascular screening device.Grouped the patients by type of CHD, the result of coronary arteriongraphy PWV and ABI.Compared the APN,PWV,ABI of each group.Results The APN of ACS group was lower than that of normal group and SAP group.while the APN of SAP group was lower than that of normal group.The PWV of CHD group was higher than that of normal group,the ACS group was higher than that of SAP group and normal group,SAP group was higher than normal group,the difference was of statistical significance.The ABI of ACS group was lower than that of normal group and SAP group,the difference of SAP group and normal group was of no statistical significance.The APN of CHD group was lower than that of normal group,the trifurcate vessel diseased group was lower than normal group,single vessel diseased group and double vessel diseased group.the double vessel diseased group was lower than that of single vessel diseased group and the normal group.There was statistical significance in every two group but the single vessel diseased group and the normal group.The ABI of the trifurcate vessel diseased group was lower than normal group,single vessel diseased group,and double vessel diseased group.the double vessel diseased group was lower than that of single vessel diseased group and the normal group.there was no statistical significance between single vessel diseased group and normal group.Tested the PWV of patients and grouped them by the PWV,there was 27 patients in PWV＜1400cm/s group,32 patients in 1400cm/s～1800cm/s group,29 patients in PWV＞1800cm/s group,compared the APN and ABI of each group,there was statistical significance between every two groups.Grouped patients by ABI,compared the APN and PWV of every two groups,the APN of ABI＜0.9 group was lower than that of ABI＞0.9 group and the PWV higher was higher.Conclusion The plasma APN levels are significantly lower in patients with CHD,the PWV is higher,the ABI is lower.The PWV will be higher and the ABI will be lower,while the APN of CHD patients decrease.The levels of plasma APN has close relationship with the severity of coronary artery stenosis,the stability of atherosclerotic lesion.The APN,ABI and PWV might be new risk factors of CHD, and provide a new and convenient way for us to evaluate and diagnose the severity of coronary artery diseaseDynamic monitoring of APN,PWV and ABI maybe provide a new way of CHD early diagnosis,pathogenetic condition monitoring and prognosis judgement for the clinician.更多还原