冠心病患者妊娠相关血浆蛋白A含量及血管内皮功能关系探析.docVIP

冠心病患者妊娠相关血浆蛋白A含量及血管内皮功能关系探析 　 作者：梅卫义， 杜志民， 胡承恒， 伍贵富， 李怡， 罗初凡， 高修仁 【摘要】 【目的】 探讨冠心病患者血循环妊娠相关血浆蛋白A(PAPP-A)水平与内皮功能的关系。【方法】64例冠心病患者，其中稳定型心绞痛组34例，急性冠脉综合征组30例，分别检测其相关内皮功能，包括肱动脉血流介导的血管舒张反应(FMD)和高敏C-反应蛋白(hs-CRP)、内皮素(ET)、一氧化氮(NO)水平，并用酶联免疫法检测血清PAPP-A。【结果】 稳定型心绞痛组患者同急性冠脉综合征组相比PAPP-A［(6 × 10-3± 5 × 10-3) U/L与(19 × 10-3± 13 × 10-3) U/L, P＜ 0.05］、hs-CRP [(0.5±0.3)mg/L与(3.6±2.2) mg/L, P＜ 0.01]、NO [(57±4) ?滋mol/L与(45±5)?滋mol/L, P＜ 0.05］和FMD (6.0%±0.8%与3.3%±1.2%, P＜ 0.05)的差异有统计学意义。逐步选择多重回归分析，按α＝0.10水准，发现PAPP-A与hs-CRP和FMD存在直线关系，Lnhs-CRP的偏相关系数为0.333 (95%置信区间: 0.138～0.527, P＜ 0.01)，FMD的偏相关系数为－0.623 (95% CI: －1.144～－0.102, P＜ 0.05)，其中常数项为5.570。高PAPP-A（＞11.094×10-3 U/L）患者hs-CRP明显增高[(5.3±4.2)mg/L与(1.3±0.6) mg/L, P＜ 0.01)，FMD则降低(3.3%±2.4%与6.2%±3.6%, P＜ 0.05)。【结论】 PAPP-A可作为间接评估冠心病患者血管内皮功能的指标之一。 【关键词】 冠状动脉粥样硬化疾病； 妊娠相关血浆蛋白A； 内皮功能； 斑块稳定性 Abstract：【Objective】 To investigate the relationship between the levels of circulating pregnancy-associated plasma protein A (PAPP-A), a novel marker of atherosclerotic plaque activity, and vascular endothelial function in the patients with coronary atherosclerosis disease. 【Methods】 Sixty-four patients, 34 with stable angina pectoris (SAP group) and 30 with acute coronary syndrome (ACS group), were measured endothelial function by detecting the brachial artery flow-mediated vasodilation (FMD), the levels of high-sensitive C-reactive protein (hs-CRP), endothelins (ET), and nitric oxide (NO). Serum PAPP-A levels were determined by sandwich enzyme-linked immunosorbent assay (ELISA) as well. 【Results】 There were significant differences between SAP groups and ACS group in terms of PAPP-A ［(6×10-3±5×10-3) U/L vs.(19×10-3±13×10-3) U/L, P＜ 0.05］, hs-CRP ［(0.5±0.3)mg/L vs.(3.6±2.2) mg/L, P＜ 0.01］, NO ［(57±4) ?滋mol/L vs. (45±5)?滋mol/L, P＜ 0.05］ and FMD (6.0%±0.8%与3.3%±1.2%, P＜ 0.05). Using the method of stepwise multiple linear regression and correlation, at the levels of α＝0.10, we found that LnPAPP-A was related to Lnhs-CRP and FMD. The constant of the model is 5.57