胎盘生长因子在冠状动脉血运重建中的意义

ROLES OF PLACENTAL GROWTH FACTOR IN PERCUTANEOUS CORONARY ANGIOPLASTY AND STENT IMPLANTATION

目的探讨胎盘生长因子(placental growth factor,PlGF)在冠状动脉血运重建中的意义。方法2006年5月-2007年3月,对61例以胸痛为主要表现的患者行冠状动脉造影检查,记录Gensini冠脉病变积分。其中男53例,女8例;平均年龄61岁。对冠脉病变严重的26例患者行经皮经腔冠状动脉成型术(percutaneous transluminal coronary angioplasty,PTCA)及支架置入术,术后观察不良心血管事件发生情况。另取28例健康志愿者作为对照组,所有观察对象均抽静脉血测定血浆PlGF水平。结果根据冠状动脉造影结果,胸痛患者可分为冠心病组(n=45)与非冠心病组(n=16)。冠心病组血浆PlGF水平为(10.70±0.49)ng/L,明显高于非冠心病组(4.53±0.64)ng/L和对照组(3.64±0.36)ng/L,且差异均有统计学意义(P<0.001),非冠心病组与对照组间差异无统计学意义(P>0.05)。相关分析显示,血浆PlGF水平与Gensini冠状动脉病变积分成强正相关(r=0.918,P<0.01)。PTCA及支架置入患者术后30d随访,4例发生不良心血管事件,其PlGF水平为(13.98±3.39)ng/L,明显高于未发生心血管事件的患者(7.25±2.96)ng/L,且差异有统计学意义(P<0.01)。结论检测血浆PlGF水平在不明原因胸痛的鉴别诊断中具有一定意义,有助于冠心病的早期诊断;血浆PlGF水平越高,提示冠状动脉病变程度越严重;血浆PlGF水平对冠状动脉血运重建术后不良心血管事件的发生有潜在预测价值。

Objective To investigate the value of plasma placental growth factor （PlGF） in percutaneous coronary angioplasty and stent implantation. Methods From May 2006 to March 2007, 61 patients （53 males and 8 females, mean age 61 years） and 28 normal controls were included. All patients present with acute chest pain and underwent coronary angiography, the lesion severity of coronary arteries was assessed by Gensini coronary scoring system. Of them, 26 patients having serious coronary lesion underwent （percutaneous transluminal coronary angioplasty, PTCA） and stent implantation. Cardiovascular events were recorded after 30 days. Plasma PlGF was determined by ELISA. Results According to the angiography, the patients could be divided into CAD group （n=45） and Non- CAD group （n=16）. Plasma PlGF level in CAD group was significantly higher than that in Non-CAD group and control group [（10.70 ± 0.49） ng/L vs （4.53 ± 0.64） ng/L vs （3.64 ± 0.36） ng/L, P 〈 0.001）], and there was no significant difference between the non-CAD group and control group （P 〉 0.05）. A significant positive correlation was found between Gensini coronary score and plasma PlGF level （r=0.918, P 〈 0.01）. Moreover, patients with cardiovascular events had a higher PlGF level than those without cardiovascular events after PTCA and stent implantation [（13.98 ± 3.39） ng/L vs （7.25 ± 2.96） ng/L, P 〈 0.01）]. Conclusion PlGF level has diagnostic value in patients with acute chest pain. The measurement of plasma PlGF might be helpful for early diagnosis of coronary artery disease. Patients with higher plasma PlGF level may have more severe coronary lesion. PlGF may be one of predictors for cardiovascular events after PCI.