冠心病患者血中期因子的水平及其临床意义

Expression of midkine in the serum of patients with coronary heart disease

目的:评价中期因子(midkine,MK)在冠心病患者外周血中的水平及其临床意义。方法:采用酶联免疫吸附法(ELISA)对126例经冠脉造影证实为冠心病的患者和50例冠脉造影正常者(对照组)外周血进行MK含量的检测。冠心病组根据冠状动脉病变支数、Gensini积分分为若干个亚组。结果:(1)对照组血清MK为(284.48±12.4)pg/ml,低于冠心病组(292.55±15.53)pg/ml(P<0.05);冠心病组中,急性心肌梗死组MK为(287.30±16.56)pg/ml,心绞痛组MK为(296.50±13.55)pg/ml,心绞痛组血清MK水平明显高于急性心肌梗死组与正常对照组(P<0.05),而急性心肌梗死组与对照组无统计学差异(P>0.05)。(2)血清MK在双支血管病变组[(297.92±10.02)pg/ml]及三支血管病变组[(308.73±7.89)pg/ml]明显高于单支血管病变组[(289.03±13.56)pg/ml]和对照组(P<0.05);Gensini积分<20组血清MK为(293.36±13.23)pg/ml,明显低于积分20～40组(305.64±8.21)pg/ml及积分≥40组(311.25±13.05)pg/ml),P<0.05。结论:急性心肌梗死早期血清MK水平无明显升高,随着病程的进展,MK水平升高,并可反映冠状动脉的病变情况。

Objective：To evaluate the clinical significance of serum midkine （MK） in patients with coronary heart disease（CHD）. Methods： The levels of serum MK were detected using enzyme-linked immunosorbent assay（ELISA）in 126 patients with coronary heart disease and 50 healthy cases. Patients with angina pectoris in the CHD were further divided into subgroups according to the number of diseased coronary branches and Gensini＇s score. Results：（1 ） Levels of serum MK were （284.48 ± 12.4） pg/ml in controls, which was significantly lower than that in patients with CHD （292.55 ± 15.53） pg/ml（P〈 0.05）. Levels of serum MK were （287.30 ± 16.56） pg/ml in patients with AMI and （296.50 ±13.55） pg/ml in patients with angina pectoris. No significant difference was found in levels of serum MK between AMI and controls, while MK levels in patients with angina pectoris were significantly higher than that in healthy controls and patients with AMI （P〈0.05） ; （2） Serum MK levels in double and three diseased coronary branches subgroup were significantly higher than that in controls and single diseased coronary branch subgroup（P〈0.05）, but no significant statistical difference was found between levels of serum MK of double diseased coronary branches subgroup and three diseased coronary branches subgroup （P〉0.05）. Serum midkine levels in Gensini＇s score 20-40 subgroup and Gensini＇s score ≥40 subgroup were significantly higher than that in controls and Gensini＇s score〈20 subgroup（P〈0.05）. Conclusion： The levels of serum MK did not significantly arise in the early stage of AMI, they markedly increased with the course of disease. MK may be useful in judging the severity of CHD.