1-棕榈酰溶血磷脂酰胆碱在诊断缺血性心脏病中的价值研究

Research on the significance of 1-palmitoyl-sn-glycero-3-phosphocholine in the diagnosis of ischemic heart disease

目的筛选缺血性心脏病(IHD)患者血清内发生重要浓度变化的代谢物并探讨其临床价值。方法检测52例IHD患者和45名正常对照者10项与诊断心肌缺血或梗死有关的血液常规生化指标[包括丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、肌酸激酶MB同工酶(CK-MB)、肌酸激酶(CK)、C-反应蛋白(CRP)和心肌肌钙蛋白T(cTnT)]。血清中主要代谢物的代谢组学分析利用高效液相色谱-质谱(HPLC-MS)技术进行。相应数据经统计分析后,筛选并鉴定出有重要变化的代谢物。结果应用HPLC-MS发现4个平均质荷比(m/z)分别为496.33、478.34、184.13和991.71的离子碎片。经鉴定,4个离子碎片均来自于1-棕榈酰溶血磷脂酰胆碱(C16:0)。IHD组血清1-棕榈酰溶血磷脂酰胆碱(C16:0)浓度为(76.35±18.28)μmol/L,明显高于正常对照组[(64.24±15.56)μmol/L,P<0.001]。IHD组其他传统心肌指标与对照组比较,除AST升高外(P<0.05),其余9项均无明显差异(P>0.05)。受试者工作特性(ROC)曲线显示,诊断IHD时1-棕榈酰溶血磷脂酰胆碱(C16:0)的ROC曲线下面积(0.90±0.03)显著高于其他常规生化指标(P<0.05)。结论 1-棕榈酰溶血磷脂酰胆碱(C16:0)对IHD具有重要的临床价值。

Objective To screen the most significantly changed metabolite in the sera of patients suffering from ischemic heart disease（IHD）,and investigate its clinical significance.Methods A total of 10 biochemical parameters involved in the diagnosis of ischemic diseases or infarction were determined including alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,alkaline phosphatase（ALP）,lactate dehydrogenase（LDH）,alpha-hydroxybutyrate dehydrogenase（α-HBDH）,creatine kinase-MB（CK-MB）,creatine kinase（CK）,C reactive protein（CRP） and cardiac troponin（cTnT） between 52 IHD patients and 45 controls.A strategy of high performance liquid chromatography-mass spectrometry（HPLC-MS） technique was used to explore the major metabolic changes in the sera of the 2 groups in view of metabolomics.The acquired data were subjected to the significance analysis to select and identify the most importantly changed metabolite.Results The results showed that 4 ion fragments were found between the 2 groups,whose average mass charge ratios（m/z） were 496.33,478.34,184.13 and 991.71.They were finally confirmed to be originated from 1-palmitoyl-sn-glycero-3-phosphocholine（C16：0）.The concentration of this metabolite was（76.35±18.28）μmol/L in IHD patients,which was higher than that in the controls [（64.24±15.56）μmol/L,P〈0.001].The 9 traditional serum parameters were not different between the patients and the controls（P〉0.05）,except the slightly elevated AST in the IHD group（P〈0.05）.Receiver operating characteristic（ROC） curve indicated that area under the curve of 1-palmitoyl-sn-glycero-3-phosphocholine（C16：0）（0.90±0.03） was larger than that of the other traditional biochemical parameters（P〈0.05）.Conclusions 1-palmitoyl-sn-glycero-3-phosphocholine（C16：0） has clinical significance for the diagnosis of IHD.