ST段抬高急性心肌梗死患者血清氧化低密度脂蛋白抗体-IgM水平与冠状动脉病变程度及住院期间预后的相关研究

Serum autoantibodies against oxidized low-density lipoprotein IgM in patients with ST-segment elevation acute myocardial infarction： correlations with coronary lesions and in-hospital prognosis

目的：探讨血清氧化低密度脂蛋白抗体-IgM（ox-LDL-Ab IgM）水平在ST段抬高急性心肌梗死（STEMI）患者中与冠状动脉病变程度及近期预后的相关性。方法选取2008年8月至2009年5月诊断明确并行急诊经皮冠状动脉介入（PCI）治疗的STEMI患者95例，根据冠状动脉造影结果分为单支病变组、双支病变组及三支病变组，并以Gensini积分评价冠状动脉狭窄程度，分别测定血清ox-LDL-Ab IgM、丙二醛（MDA）、血脂，计算体质量指数（BMI），统计患者住院期间心血管事件发生情况，分析ox-LDL-Ab IgM水平与冠状动脉病变程度及近期预后的关系。结果 STEMI患者血清ox-LDL-Ab IgM水平随冠状动脉病变支数增加而降低（P＜0.05），但与Gensini积分无明显相关性（P＞0.05）；ox-LDL-Ab IgM水平与血脂、血糖水平等无明显相关性（P＞0.05），与MDA水平呈显著负相关（r＝-0.319，P＜0.05）；ox-LDL-Ab IgM水平与患者住院期间心血管事件发生率呈显著负相关（r＝-0.708，P＜0.05），logistic回归分析显示， ox-LDL-Ab IgM是STEMI患者住院预后的保护因素（OR＝-0.588，P＜0.05）。结论血清ox-LDL-Ab IgM水平可在一定程度上反映STEMI患者冠状动脉病变的严重程度。其可能通过调节机体氧化应激水平，减少LDL氧化修饰生成ox-LDL，从而减轻冠状动脉粥样硬化的面积，可能对STEMI患者近期预后具有保护作用。

Objective To investigate the relationship of serum autoantibodies against oxidized low-density lipoprotein IgM （ox-LDL-Ab IgM） with coronary lesions and clinical prognosis in patients with ST-segment elevation acute myocardial infarction （STEMI）. Methods From August 2008 to May 2009, 95 patients with STEMI undergoing elective coronary angiography （CAG） and emergent percutaneous coronary intervention （PCI） were enrolled in the study. All patients were divided into single-, double- and triple-vessel lesion groups according to the numbers of vessels with significant stenosis. The ox-LDL-Ab IgM, maleic dialdehyde （MDA）, serum lipids, body mass index （BMI）, Gensini’s score, and cardiovascular events during hospitalization were recorded and calculated. The relationship of serum level of ox-LDL-Ab IgM with coronary lesions and short-term prognosis was analyzed. Results The serum level of ox-LDL-Ab IgM was reduced with the increase in stenostic vessel numbers in STEMI patients （P〈0.05）, but had no correlation with Gensini’s score （P〉0.05）. The serum level was negatively correlated with serum MDA （r=-0.319, P〈0.05）, but no obvious correlation was found with serum lipids and blood glucose （P〉0.05）. There was negative correlation between the serum level of ox-LDL-Ab IgM and cardiovascular events during hospitalization （r=-0.708, P〈0.05）. Logistic linear regression analysis showed that ox-LDL-Ab IgM was a protective factor for patients with STEMI （OR=-0.588, P〈0.05）. Conclusion The serum level of ox-LDL-Ab IgM reflects the severity of atherosclerosis in patients with STEMI. ox-LDL-Ab IgM may reduce modification of LDL to ox-LDL through regulating oxidative stress, and then attenuates the coronary atherosclerosis area. It may play a protective role in the short-term prognosis in STEMI patients.