外周血内脂素水平检测对冠状动脉粥样硬化性心脏病的临床应用价值

Clinical significance of the detection of visfatin in the peripheral blood of patients with coronary atherosderotic heart disease

目的检测冠状动脉粥样硬化性心脏病（冠心病）患者外周血内脂素水平，探讨内脂素水平与冠心病病变程度的关系。方法收集2011年1-6月住院并行冠状动脉造影检查确诊为冠心病的患者220例（冠心病组），其中稳定型心绞痛74例（稳定型心绞痛组），不稳定型心绞痛60例（不稳定型心绞痛组），急性心肌梗死86例（心肌梗死组），选取健康体检的冠状动脉造影正常者20例作为对照组。采用全自动生化仪检测各组血清总胆固醇（TC）、三酰甘油（’rG）、高密度脂蛋白胆固醇（HDL．C）、低密度脂蛋白胆固醇（LDL．C）等相关生化指标。采用酶联免疫吸附双抗体夹心法检测血清内脂素水平。比较各组血清生化指标与内脂素水平，分析血清内脂素水平与各生化指标的相关性。结果冠心病组血清内脂素水平为（34．07±5．51）μg／L，显著高于对照组的（13．22±3．17）μg，L（P〈0．05）。不同类型冠心病组血清TC、LDL-C与对照组比较差异无统计学意义（P〉0．05）。稳定型心绞痛组、不稳定型心绞痛组、心肌梗死组血清TG、HDL．C、内脂素水平[（1．44±0．27）mmol／L、（1．16±0．12）mmol／L、（21．36±3．35）μg／L，（1．84±0．32）mmol／L、（1．01±0．08）mmol／L、（27．78±4．47）μg／L，（2．31±0．34）mmol／L、（0．93±0．06）mmol／L、（33．14±5．66）μg／L]与对照组[（0．93±0．25）mmol／L、（1．48±0．24）mmol／L、（13．22±3．17）μg／L]比较差异有统计学意义（P〈0．05或〈0．01）。不稳定型心绞痛组和心肌梗死组血清TG、Gensini积分、血清内脂素水平明显高于稳定型心绞痛组，血清HDL-C明显低于稳定型心绞痛组，差异有统计学意义（P〈0．05）。心肌梗死组Gensini积分、血清内脂素水平明显高于不稳定型心绞痛组，血清HDL-C明显低于不稳定型心绞痛组，差异有统计学意义（P〈0．05）。Spearman相关分析显示冠心病组的血清内脂素水平与TG和Gensini积分呈正相关（P〈0．05或〈0．01），与HDL-C呈负相关（P〈0．01），与TC和LDL-C无相关性（P〉0．05）。结论外周血内脂素水平的升高可能是冠心病的一个危险因素，其水平的变化可以较好地反映冠状动脉病变的严重程度。

Objective To detect the level of visfatin in the peripheral blood of patients with coronary atherosclerotic heart disease （coronary heart disease）,and investigate the correlation between the level of visfatin and the lesion degree of coronary heart disease. Methods Two hundred and twenty patients who were diagnosed as coronary heart disease by coronary artery angiography from January to June 2011 （coronary heart disease group） were enrolled in this study,including 74 cases with stable angina pectoris（stable angina pectoris group）, 60 eases with unstable angina pectoris （unstable angina peetoris group）, and 86 cases with acute myocardial infarction （myocardial infarction group）. And 20 healthy persons with normal coronary artery angiography were selected as control group. The biochemical parameters of triglyceride （TG）,total cholesterol （TC）,high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C） were detected by biochemistry autoanalyzer. The level of serum visfatin was detected by ELISA analysis. The serum biochemical parameters and serum visfatin among all the groups were compared and the correlation between them was analyzed. Results The level of serum visfatin of coronary heart disease group [（34.07 ±5.51） μg/L] was significantly higher than that of control group [（13.22 ± 3.17） μg,/L]（P 〈 0.05 ）. TC and LDL-C of different coronary heart disease groups had no significant differences compared with that of control group （P 〉 0.05 ）. TG,HDL-C and serum visfatin of stable angina peetoris group,unstable angina pectoris group and myocardial infarction group [（1.44 ±0.27） mmol/L, （1.16 ±0.12） mmol/L, （21.36± 3.35） tL g/L; （ 1.84±0.32） mmo//L, （ 1.01 ±0.08） mmol/L, （27.78 ± 4.47） μ g/L; （2.31 ± 0.34） mmol/L, （0.93 ± 0.06） mmol/L, （33.14 ± 5.66）μ g/L] had statistical significance compared with those of control group [（0.93 ±0.25） mmol/L,（1.48 ±0.24） mmol/L, （13.22 ±3.17） μg/L]（P〈 0.05 or 〈0.01）. TG, Gensini score and serum visfatin of unstable angina pectoris group were significantly higher than those of stable angina pectoris group and HDL-C was obviously lower than that of stable angina peetoris group （P 〈 0.05 ）. Gensini score and serum visfatin of myocardial infarction group were significantly higher than those of unstable angina pectoris group and HDL-C was obviously lower than that of unstable angina pectoris group （P 〈 0.05 ）. Spearman correlation analysis showed that the level of serum visfatin of coronary heart disease group was positively correlated with TG and Gensini score （P 〈 0.05 or 〈 0.01 ） and negatively correlated with HDL-C （P 〈 0.01 ）, and had no correlation with TC and LDL-C （P 〉0.05 ）. Conclusions The high- level expression of visfatin in the peripheral blood may be a risk factor of coronary heart disease. The changes of serum visfatin can reflect the lesion severity degree of coronary artery.