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组织蛋白酶S和半胱氨酸蛋白酶抑制剂C与冠状动脉临界病变形态学和预后的相关性 被引量:1

Relationship of plasma levels of cathepsin S and cystatin C with quantitative angiographic morphology andprognosis of coronary borderline lesions
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摘要 目的探讨血浆组织蛋白酶S(cathepsins)和半胱氨酸蛋白酶抑制剂C(cystatinc)水平与冠状动脉临界病变形态学及预后的关系。方法人选经冠状动脉造影证实的冠状动脉临界病变(冠状动脉主要分支管腔直径局限狭窄20%~70%)患者668例,其中动脉粥样硬化(AS)组229例,稳定性心绞痛(SA)组192例,不稳定性心绞痛(uA)组247例。对符合条件的冠状动脉进行定量冠状动脉造影(QcA)分析,评价病变狭窄程度和斑块形态学;应用绝对定量蛋白芯片法测定血浆cathepsinS水平,应用增强的免疫比浊法测定血浆cystatinC水平;随访12~36个月,评估血浆cathepsinS、cystatinC对主要不良心脏事件的预测作用。结果UA组、SA组患者血浆cathepsinS、cystatinC水平高于As组,cathepsinS分别为(11654.6±3308.5)、(10433.2±2882.5)及(7580.7±2473.8)ng/L,均P〈0.01;cystatinC分别为(1.01±0.23)、(0.94±0.27)及(0.85±0.25)mg/L,均P〈0.01),且uA组cathepsinS和cystatinC水平高于SA组(均P〈0.01)。QCA分析结果显示,SA组管腔面积狭窄率在最大,AS组最小(P〈o.01);uA组斑块面积高于SA组、As组(P〈o.01)。病变形态学方面,UA组偏心病变、复杂病变的发生率高于AS组、SA组(P〈0.05和P〈0.01)。多因素回归分析结果显示,校正性别、年龄及传统危险因素后,复杂病变[相对危险度(RR)-2.15,95%CI1.03~4.48,P〈0.05]、钙化病变(RR-5.32,95%CI:2.68~10.59,P〈0.01)、cathepsinS(RR-1.34,95%CI:1.14~1.56,P〈0.01)及cystatinC(RR-5.11,95%CI:1.61~16.25,P〈0.01)与发生不良心血管事件相关。结论UA患者血浆cathepsinS和cystatinC水平高于SA和AS患者。血浆cathepsinS水平对心脏事件的预测作用较弱,血浆cystatinC水平是冠状动脉临界病变患者发生心脏事件的较强预测因子。 Objective To investigate the relatlonslalp ot plasma levers of cuthepsin C with quantitative angiographic morphology and prognosis of coronary borderline lesions. Methods A total of 668 patients with coronary borderline lesions confirmed by coronary angiography (a segmental stenosis with 20 %-70 % lumen diameter reduction in the main branch of coronary artery) were recruited. Among them, there were 229 patients diagnosed as atherosclerosis (AS group), 192 patients diagnosed as stable angina (SA group), and 247 patients diagnosed as unstable angina (UA group). Quantitative coronary angiography (QCA) was performed to evaluate the stenosis extent andplaque morphology. Plasma cathepsin S level was determined by quantibody human cytokine array and plasma cystatin C level was measured by enhanced immunoturbidimetry. Major adverse cardiovascular events (MACEs) were evaluated during a 12-36-month follow-up period. Results Plasma levels of cathepsin S and cystatin C were significantly higher in UA group and SA group than in AS group [cathepsin S.. (11654. 6±3308. 5) ng/L, (10433.2±2882.5) ng/L versus (7580.7±2473.8) ng/L; eystatin C: (1.0!0.2) mg/L, (0.9±0.3) mg/L and (0.9±0.3) mg/L, all P〈0. 011. Moreover, plasma levels of cathepsin S and cystatin C were higher in UA group than in SA group (both P〈0.01) QCA analysis showed that lumen area stenosis was highest in SA group and lowest in AS group (both P〈0.01). Plaque area was higher in UA group than in the other groups (both P〈0. 001). With regard to lesion morphology, the incidences of eccentric lesion and complex lesion were significantly higher in UA group than in AS and SA groups (P〈0.05, P〈0.01). Multivariate analysis showed that after adjustment for gender, age and traditional risk factors, the complex lesion, calcified lesion, plasma cathepsin S and eystatin C levels were significantly associated with the occurrence of MACEs (RR=2.15, 5.32, 1.34, 5. 11, 95CI:1. 03-4. 48, 2.68-10.59, 1.14-1.56, 1.61 16.25, P〈0.05, 0.01, 0.01, 0.01, respectively). Conclusions Plasma cathepsin S and eystatin C levels are significantly higher in UA patients than in SA and AS patients with coronary borderline lesions. The value of plasma cathepsin S level in predicting cardiac events is relatively weak, while plasma cystatin C level is a strong predictor of cardiac events in patients with coronary borderline lesions.
出处 《中华老年医学杂志》 CAS CSCD 北大核心 2013年第6期577-581,共5页 Chinese Journal of Geriatrics
基金 北京市科技计划项目(D0906006040191)
关键词 组织蛋白酶类 半胱氨酸蛋白酶抑制剂 冠状血管造影术 预后 Cathepsins Cysteine proteinase inhibitors Coronary angiography Prognosis
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