血清脂肪细胞型脂肪酸结合蛋白及脂联素水平与冠心病的相关性

Association between adipocyte fatty acid binding proteins/adiponectin and coronary artery stenosis

目的 探讨脂肪细胞型脂肪酸结合蛋白（A-FABP）、脂联素和A-FABP/脂联素比值与冠心病及冠状动脉病变程度的相关性.方法 经冠状动脉造影入选340例患者,分为冠心病组（211例）和非冠心病对照组（129例）,用ELISA法测定血清AFABP及脂联素水平,冠状动脉病变程度用病变血管支数和Gensini积分表示.并从上述患者中选取年龄、性别、体质指数相匹配的冠心病及非冠心病者各10例,分离外周血单核细胞,佛波酯刺激为巨噬细胞后取培养上清,用ELISA法测定培养上清液A-FABP及脂联素浓度.结果 （1）冠心病组血清A-FABP水平[18.3（13.2,22.8）μg/L]较非冠心病组[16.4（13.5,20.4）μg/L]高,但差异未达到统计学意义（P=0.088）;冠心病组血清脂联素水平低于非冠心病组[13.9（9.8,17.1）mg/L比19.7（14.5,27.6）mg/L,P＜0.05].（2）随着冠状动脉病变支数的增加,血清A-FABP水平呈升高、脂联素水平呈递减趋势;Gensini积分与血清A-FABP呈正相关（r=0.120,P=0.043）,与脂联素呈负相关（r=-0.405,P=0.007）.（3）冠心病组血清A-FABP/脂联素比值明显高于非冠心病组[（1.51±0.79）μg/mg比（0.89±0.30）μg/mg,P＜0.01];血清A-FABP/脂联素比值与Gensini积分的相关性更明显（r=0.531,P=0.000）.（4）冠心病者单核源性巨噬细胞A-FABP/脂联素比值高于非冠心病者[（0.51±0.19）μg/mg比（0.36±0.11）μg/mg,P＜0.05].结论 高A-FABP和低脂联素水平可能是反映严重冠状动脉狭窄的新的血清标记物.A-FABP/脂联素比值较单独A-FABP或脂联素与冠状动脉病变的相关性更好.

Objective To observe the relationship between serum and monocyte-derivedmacrophages secreted adipocyte fatty acid binding protein（A-FABP）, adiponectin（or A-FABP/adiponectin ratio）and coronary artery disease. Methods Three hundred and forty subjects underwent coronary angiography（CAG）were classified into CAD group（n = 211）and non-CAD group（n = 129）according to the CAG results. The severity of coronary artery stenosis was assessed by the numbers of involved coronary artery branches and the sum of the Gensini scores. Fasting venous blood was collected from all subjects and peripheral monocytes were isolated from 20 subjects（10 selected from each group with age-, gender-, and BMI-matched）. Peripheral blood monocytes were obtained and stimulated into macrophages with PMA, cell culture supernatant was collected. The concentration of serum/supernatant A-FABP and adiponectin levels were assayed by enzyme-linked immunosorbent assays. Results（1）A-FABP levels tendend to be higher in CAD patients compared to non-CAD subjects[18. 3（13.2,22. 8）μg/L vs. 16. 4（13.5,20. 4）μg/L,P = 0. 088]. The concentration of adiponectin in CAD group was significantly lower than those in non-CAD group[13.9（9.8,17.1）mg/L vs. 19.7（14.5,27.6）mg/L,P 〈0.05].（2）The A-FABP levels increased and the adiponectin levels decreased as the number of stenotic vessels increased. Gensini scores were positively correlated with serum A-FABP（r = 0. 120, P = 0.043）and inversely correlated with adiponectin（r = - 0. 405, P = 0. 007）.（3）The difference in A-FABP/adiponectin ratio was moreprominent between subjects with CAD and subjects without CAD[（1.51 ±0. 79）μg/mg vs.（0. 89 ±0. 30）μg/mg, P 〈 0. 01]and there was a stronger positive correlation of Gensini score to A-FABP/adiponectin ratio（r =0. 531, P =0. 000）.（4）Monocyte-derived-macrophages from patients with CAD had higher A-FABP/adiponectin ratio than that in patients without CAD[（0. 51 ± 0. 19）μg/mg vs.（0. 36 ± 0. 11）μg/mg, P 〈 0. 05]. Conclusions Increased levels of serum A-FABP and reduced levels of adiponectin in CAD patients serves as a novel biomarker for the severity of the coronary stenosis. A-FABP/adiponectin ratio is superior to A-FABP or adiponectin alone on predicting CAD risks.