冠心病患者血清几丁质酶-3样蛋白-1水平变化及缬沙坦的干预作用

Changes of serum YKL -40 levels in coronary heart disease patients and intervention effect of val, sartan

目的研究冠心病患者血清几丁质酶-3样蛋白-1（YKL-40）水平变化及缬沙坦（代文）对其表达的影响。方法选取2010年8月至2011年5月在我院心内科住院并行冠状动脉造影检查的患者109例，根据冠状动脉造影结果结合临床病史分为正常对照组26例、稳定型心绞痛（SAP）组35例、急性冠状动脉综合征（ACS）组48例；ACS组再进行分组，28例服用缬沙坦6个月以上者为缬沙坦亚组，近6个月内未应用任何血管紧张素Ⅱ受体桔抗剂及血管紧张素转化酶抑制剂者20例为非缬沙坦亚组。采用酶联免疫吸附法（ELISA）测定患者血清中YKL-40浓度，比较各组间YKL-40水平差异。采用Gensini评分系统测定冠心病患者冠状动脉病变程度，并与血清YKL-40水平进行相关性分析。结果与对照组相比，SAP组及ACS组血清YKL-40水平显著升高，差异均有统计学意义（P〈0．01）；且ACS组血清YKL-40水平高于SAP组（P〈0．01）。缬沙坦组血清YKL-40水平低于非缬沙坦组，差异有统计学意义（P〈0．05）。Pearson直线相关分析显示：ACS患者血清YKL-40水平与Gensini评分呈正相关（r=0．705，P〈0．01）；SAP组血清YKL-40水平与Gensini评分无明显相关性（r=0．312。P〉0．05）。结论YKL-40作为一种炎症因子与冠状动脉粥样硬化斑块的不稳定性有关，可能在冠心病患者冠状动脉病变的发生、发展中起重要作用；缬沙坦可能存在抗炎作用。

Objective To observe the role of serum YKL -40 in coronary heart disease and the change after valsartan treatment. Methods One hundred and nine patients were analyzed from August 2010 to May 2011. Coronary angiography were detected for all patients. According to the coronary angiography results and clinical history, the patients were divided into normal control group for 26 cases, stable angina （SA） patients for 35 cases and acute coronary syndrom （ACS） patients for 48 cases. ACS patients were sub divided into two groups according to valsartan reatment. The serum levels of YKL -40 was measured by enzyme linked immunosorbent assay （ELISA） and the level of serum YKL - 40 in different groups was measured. The degree of coronary artery stenosis was assessed by Gensini score, and the correlation between serum level of YKL -40 and Gensini score was analyzed. Results Compared to normal control group, the level of serum YKL -40 was significantly increased in SAP group and ACS group （ P 〈0.01 ）. Compared with SAP group, the serum YKL - 40 concentration of ACS group was markedly increased （ P 〈 0.01 ）. Additionally, the serum level of YKL - 40 in ACS patients treated with valsartan were lower than those with no valsartan treatment （ P 〈 0.05）. Liner regression showed the serum level of YKL - 40 was positively correlated with Gensini score （ r = 0. 705 ,P 〈0.01 ） in ACS group, there was no correlation found between YKL-40 and Gensini score in SAP group （ r = 0. 312, P 〉 0.05）. Conclusions As an inflammatory cytokine, YKL -40 is correlated with the instability of atherosclerotic plaque in coronary heart disease patients, it may play an important role in the development of coronary artery obstructions in the coronary heart disease, and valsartan may improve the disease by inhibiting this cytokine.