不同亚组冠心病患者及PCI后血清妊娠相关蛋白-A与胰岛素样生长因子-1检测

Detection of pregnancy-associated plasma protein A and insulin-like growth factor-1 in the subgroups of coronary heart disease and their changes after percutaneous coronary intervention

目的探讨冠心病患者妊娠相关蛋白-A(PAPP-A)及胰岛素样生长因子-1(IGF-1)与冠状动脉病变程度的关系及经皮冠状动脉介入治疗(PCI)后的变化。方法42例冠心病患者分为急性心肌梗死(AMI)组12例,不稳定型心绞痛(UAP)组15例,稳定型心绞痛(SAP)组15例,均经冠状动脉造影(CAG)确诊,其中24例行PCI术。另选16例CAG结果正常者为对照组。采用酶联免疫吸附法(ELISA)测定冠心病各亚组与对照组及PCI术后血清PAPP-A、IGF-1水平。结果AMI组和UAP组患者血清PAPP-A、IGF-1水平明显高于SAP组和对照组(P<0.01)。SAP组患者血清IGF-1水平明显低于对照组(P<0.01);冠心病单支病变组、双支病变组、三支病变组患者血清PAPP-A、IGF-1水平均高于对照组(P<0.05),但单支病变组、双支病变组、三支病变组之间差异无统计学意义(P>0.05);PCI术后患者血清PAPP-A、IGF-1水平高于术前(P<0.01);AMI组、UAP组患者血清PAPP-A与IGF-1水平呈正相关(r=0.48,P<0.01)。结论PAPP-A、IGF-1参与动脉硬化粥样斑块的发生发展过程,可作为预测斑块稳定性的标志物,可能与PCI术后再狭窄有关。

Aim ： To investigate the relationship between pregnancy-associated plasma protein A （PAPP-A） and insulin-like growth factor-1 （IGF-1） and the severity of coronary heart disease （CHD）and their changes after percutaneous coronary intervention（PCI）. Methods： A total of 42 patients with CHD were divided into acute myocardial infarction （AMI） group （ n = 12 ） , unstable angina pectoris （UAP） group （ n = 15 ） , and stable angina pectoris （SAP） group （ n= 15 ） , among whom ,24 cases received PCL Sixteen normal subjects without CHD served as the control group. The serum levels of PAPP-A and IGF-1 were measured by enzyme linked immunosorbent assay（ELISA）. Results： The serum levels of PAPP-A and IGF-1 were higher in the AMI and UAP groups than those in the SAP and control groups （P 〈 0.01 ） ; the serum levels of IGF-1 in the SAP group was lower than those in the control group（P 〈0.01 ） ; the serum levels of PAPP-A and IGF-1 in the single vessel lesion,the double vessel lesion and three vessel lesion groups were higher than those in the control group （ P 〈 0.05 ） , but there were no significant differences in serum levels of PAPP-A and IGF-1 among the single vessel lesion, the double vessel lesion and three vessel lesion groups（P 〉0.05）. The serum levels Of PAPP-A and IGF-1 after PCI were higher than those before PCI（P 〈 0.01 ）. A significant positive correlation was found between PAPP-A and IGF-1 level in the AMI and UAP group （ r = 0.48 ,P 〈 0.01 ）. Conclusion： PAPP-A and IGF-1 may play an important role in the occurance and development of atheromatous plaque of the patients with AMI and UAP, and probably act as one of the biomarkers of vulnerable plaques. They may be concerned with restenosis after PCI.