内脏脂肪素在冠心病患者中的发病学意义

The significance of visfatin in patients with coronary heart disease

目的探讨冠心病（CHD）患者血浆内脏脂肪素（visfatin）的变化及其临床意义。方法人选患者400例，冠心病组310例，其中ACS组217例，稳定型心绞痛（SAP）组93例，对照组90例。检测患者血浆内脏脂肪素浓度。并经选择性冠状动脉造影检查，明确冠状动脉病变情况。CHD组中85例患者接受64层螺旋CT冠状动脉成像检查，对冠状动脉内的主要斑块进行评价。结果冠心病组visfatin、LDL、BMI、血糖水平[（128．18-1-13．86）ng／ml，（3．63±1．48）mmol／L，（26．184-1．82）ks／ITI。，（7．25±2．03）mmol／L]明显高于对照组[（75．964-10．27）ng／ml，（2．64±0．53）mmol／L，（23．51±0．89）kg／m。，（5．11±1．53）mmol／L，P〈0．05]，ACS组visfatin水平[（145．57±19．95）ng／m1]明显高于SAP组[（110．79±7．78）ns／ml，P〈0．05]。随冠状动脉病变类型复杂程度和冠状动脉病变程度的加重，visfatin浓度逐渐升高（P〈0．05）；CHD患者的软斑块组、纤维斑块组较钙化斑块组血浆内脏脂肪素浓度明显升高，其差异有统计学意义（P〈0．05）；HDL—C与冠脉病变Gensini评分呈负相关（r=-0．055，P〈0．05），LDL—C、GLu、visfatin与冠脉病变Gensini评分呈正相关（r=0．464，0．279，0．531，P〈0．05）。结论冠心病患者血浆visfatin水平增高，其影响脂质代谢，可能是促进动脉粥样硬化发生、发展的重要炎症因子，结合64层螺旋CT检查，对判断冠脉病变情况及斑块稳定性具有一定的价值。

Objective To investigate the change of plasma visfatin in patients with coronary heart disease and its clinical significance. Methods A total of 310 patients with coronary heart disease （ACS group： n =217; SAP group： n =93） and ofg0 healthy subjects with a matched age and gender were included in this study. The plasma concentration of visfatin of each subject was measured using ELISA assay, and each patient underwent selective coronary angiography examination. A total of 85 cases of patients in CHD group underwent 64-slice CT coronary imaging to evaluate the main plaque within the coronary. Results The visfatin, LDL, BMI, blood glucose levels was significantly higher in CHD group[ （128. 18±13. 86）ng/ml, （3.63±1.48） mmol/L, （ 26. 18±1.82） kg/m2, （7. 25± 2. 03 ） mmol/L ] than in control group [ （ 75.96 ± 10. 27 ） ng/rnl, （2. 64 ± 0. 53 ） retool/L, （23.51± 0. 89） kg/m2, （5. 11 ±1.53 ） mmol/L, P 〈 0. 05 ], respectively. The visfatin level in the ACS group [ （ 145.57± 19. 95 ） ng/ml ] was significantly higher than the SAP group [ （110. 79± 7.78）ng/ml, P 〈0. 05 ]. The visfatin concentration gradually increased with the aggravation of the complexity of coronary lesion types and severity of coronary lesions（ P 〈0. 05）. The plasma visfatin con- centrations in Soft plaque group and the fibrous plaque group were significantly higher than calcified plaque （ P 〈 0. 05 ）. HDL-C and Gensini score of coronary lesions were negatively correlated （ r = -0. 055, P 〈 0. 05） ; LDL-C, Glu, and visfatin was positively correlated with coronary lesions Gensini score （ r = 0. 464, 0. 279,0. 531, P 〈 0. 05）, respectively. Conclusions The plasma visfatin level in patients with Coronary heart disease increased and affected its lipid metabolism. It may be an important inflammatory factors promo- ting arterial atherosclerosis occurs and development, which has a certain value to the judgment of coronaxy lesions and plaque stability combined with 64-slice spiral CT examination.