内脂素与脂联素在急性心肌梗死经皮冠状动脉介入术后发生心力衰竭中的意义

Significance of visfatin and adiponectin to heart failure after treatment of acute myocardial infarction with percutaneous coronary intervention

目的探讨内脂素与脂联素在急性心肌梗死(AMI)经皮冠状动脉介入术(PCI)后发生心力衰竭中的临床意义。方法选取福建中医药大学附属福州市中医院心内科、重症医学科2012年1月至2014年6月因AMI行PCI的患者123例,其中男性76例,女性47例。术后发生(心力衰竭)心衰患者49例(心衰组),未发生心衰患者74例(非心衰组)。另外选取30例稳定型心绞痛患者(心绞痛组),20例健康体检者(正常组)。检测所有入选者肌钙蛋白I(c Tn I)、肌酸激酶同工酶(CK-MB)、N末端B型脑钠肽前体(NT-pro BNP)、C反应蛋白(CRP)、白细胞计数(WBC)、中性粒细胞计数(NE)、低密度脂蛋白胆固醇(LDL-C)、内脂素及脂联素等指标。超声检测左室射血分数(LVEF),左室舒张末期内径(LVEDd),左室收缩末期内径(LVEDs)。结果与正常组比较,心绞痛组、非心衰组以及心衰组内脂素水平升高,脂联素降低,差异均有统计学意义(P均<0.05)。心衰组较心绞痛组和非心衰组脂联素降低,差异有统计学意义(P均<0.05)。心衰组血清内脂素水平与c Tn I、CK-MB、NT-pro BNP、三酰甘油(TG)、总胆固醇(TC)、LDL-C、CRP、WBC、NE及LVEDs呈正相关,相关系数分别为0.568、0.485、0.502、0.541、0.394、0.429、0.205、0.366、0.389、0.305(P均<0.05),与LVEF呈负相关(r=-0.296,P<0.05)。脂联素水平与c Tn I、CK-MB、TG、TC、LDL-C、CRP及NE呈负相关,相关系数分别为-0.354,-0.425,-0.298,-0.331,-0.354,-0.253,-0.374(P均<0.05)。结论内脂素和脂联素与急性心肌梗死PCI术后心力衰竭的发生有关,可作为临床预测指标,具有广泛的应用价值。

Objective To discuss the significance of visfatin and adiponectin to heart failure after treatment of acute myocardial infarction （AMI） with percutaneous coronary intervention （PCI）. Methods The patients with AMI undergone PCI （n=123, male 76, female 47） were chosen from Jan. 2012 to June 2014, and among them there were 49 with heart failure （HF group） and 74 without heart failure （NHF group）. Other 30 patients with chronic angina pectoris were chosen as AP group, and 20 healthy controls were chosen as normal group. The indexes of cardiac troponin I （cTnI）, creatine kinase MB （CK-MB）, N-terminal pro brain natriuretic peptide （NT-proBNP）, C-reactive protein （CRP）, white blood cell count （WBC）, neutrophil count （NE）, low-density lipoprotein-cholesterol （LDL-C）, visfatin and adiponectin were detected. The changes of LVEF, LVEDd and LVEDs were detected by using ultrasonography. Results Compared with normal group, in other 3 groups visfatin level increased and adiponectin level decreased （all P〈0.05）. Adiponectin level decreased in HF group compared with AP group and NHF group （all P〈0.05）. In HF group, visfatin level was positively correlated to cTnI, CK-MB, NT-proBNP, TG, TC, LDL-C, CRP, WBC, NE and LVEDs （r=0.568, r=0.485, r=0.502, r=0.541, r=0.394, r=0.429, r=0.205, r=0.366, r=0.389and r=0.305, all P〈0.05）, and negatively correlated to LVEF （r=-0.296, P〈0.05）. Adiponectin level was negatively correlated to cTnI, CK-MB, TG, TC, LDL-C, CRP and NE （r=-0.354, r=-0.425, r=-0.298, r=-0.331, r=-0.354, r=-0.253, r=-0.374, all P〈0.05）. Conclusion Visfatin and adiponectin are correlated to heart failure after treatment of AMI with PCI, which can be taken as predictive indexes in clinic.