急性冠状动脉综合征患者血浆晚期蛋白氧化产物升高的机制及意义

The mechanism and significance of advanced oxidation protein products in acute coronary syndrome

目的通过检测急性冠状动脉综合征（ACS）患者体内晚期蛋白氧化产物（AOPP）的水平来探讨氧化应激损伤与冠状动脉粥样硬化发生发展的关系。方法入选102例冠心病患者及10例非冠心病患者，冠心病组分为AMI择期经皮冠状动脉介入治疗（PCI）35例、AMI急诊PCI24例、不稳定型心绞痛（UA）43例；分别于入院即刻、24h和48h3个时间点采集外周静脉血标本，在紫外荧光340nm及酸性条件下测定血清标本的吸光度，并以相应氯胺T浓度来表示AOPP浓度。结果AMI择期PCI组入院即刻、入院24h和入院48hAOPP浓度分别为（236．42±30．41）、（207．84±29．50）、（227．79±35．18）mmol／L．UA组分别为（239．95±39．94）、（175．92±29．46）、（156．54±28．29）mmol／L，非冠心病组分别为（57．41±13．60）、（56．11±11．90）、（61．75±12．28）mmol／L，AMI急诊PCI组分别为（97．58±23．41）、（91．77±17．40）、（113．39±17．24）μmol／L。AMI择期PCI组、UA组分别与非冠心病组对应各时间点比较，AOPP浓度明显升高（均P〈0．05）；入院即刻与入院24h（P均〈0．01）及入院48h（P〈0．05），AMI择期PCI组较急诊PCI组AOPP浓度显著升高；AMI急诊PCI组与UA组比较差异无统计学意义（P〉0．05）；治疗前后AOPP浓度比较，仅uA组48h后有明显下降（P〈0．05）。结论ACS患者血清AOPP浓度显著升高，氧化应激是AS发生发展过程中的重要环节，AOPP是反映体内氧化应激水平较好的血清学指标。

Objective To examine the advanced oxidation protein products （AOPP） in patients with acute coronary syndrome（ACS） and discuss the relationship between oxidative stress with the development of atheroselerosis（AS）. Methods Plasma were collected in 59 acute myocardial infarction （AMI） patients including 35 patients underwent selective PC1,24 patients underwent emergency PCI, 43 unstable angina pectoris （UA） patients and 10 non-coronary artery disease （non-CAD） patients. All cases underwent coronary angiography （CAG）. Plasma was collected immediately,post-24 hours and post-48 hours after admission. AOPP was determined by measurements of absorbanee（A） at 340 nm under acidic conditions via spectrophotometry. Results AOPP was （236.42 ± 30.41 ） （ n = 35 ）, （207.84 ± 29.50） mmol/L （ n = 35 ）, （ 227.79 ± 35.18 ） mmol/L （ n = 31 ） respectively immediately, post- 24 hours and post-48 hours after admission in AMI （ selective PCI ）, （ 239. 95 ± 39. 94 ） mmol/L （ n = 43 ）, （ 175.92 ± 29.46） mmoL/L（ n = 38 ）, and （ 156.54 ± 28.29 ） mmol/L （ n = 35 ） in UA group and （ 57.41 ± 13.60 ） mmol/L（n = 9） , （56.11 ± 11.90） mmol/L （ n = 10） and （61.75 ± 12.28 ） mmol/L （ n = 8 ） in non-CAD group. Compared with normal group （ without CAD）, significantly higher plasma AOPP was detected in AMI （ selective PCI ） and UA patients（ P 〈 0.05 ）. AOPP level was significantly increased in AMI selective PCI patients as compared with that of emergency PCI group immediately and post-24 hours after admission（ P 〈0.01 ） ,and post-48 hours after admission（ P 〈 0.05 ） ,but there was no statistical significance between emergency PCI and IdA group（ P 〉 0.05 ）. Conclusions Oxidative stress is an important step in the development of atheroselerosis, and tile higher levels of AOPP in ACS patients show that AOPP may be as good markers in these patients.