外周血白细胞端粒长度与急性心肌梗死严重程度和心血管危险因素的关系

The relationship between telomere length in peripheral blood leukocytes and severity of acute myocardial infarction and traditional cardiovascular risk factors

目的探讨外周血白细胞端粒长度与急性心肌梗死(AMI)严重程度和传统心血管危险因素的关系。方法连续入选2014年12月至2017年1月在空军军医大学西京医院住院的AMI患者114例,并选择同期经冠状动脉造影显示冠状动脉狭窄<50%的患者117例作为对照组。应用Gensini评分评估入选患者的冠状动脉狭窄程度,根据Gensini评分的四分位数间距将入选患者分为4组;应用Framingham危险因素评分综合评估入选患者的心血管危险因素,根据未来10年心脏病风险将入选患者分为低危组、中危组和高危组。收集所有患者在接受冠状动脉造影前的外周动脉血,采用荧光实时定量PCR检测外周血白细胞端粒长度。比较不同组间外周血白细胞端粒长度的差异及端粒长度与不同心血管危险因素的关系。结果 AMI组与对照组患者外周血白细胞端粒长度比较,差异有统计学意义[1.04(0.67,1.50)比1.26(0.83,1.67),Z=-2.47,P=0.014];Gensini评分4组间外周血白细胞端粒长度比较,差异有统计学意义(χ2=7.93,P<0.05),且外周血白细胞端粒长度与Gensini评分呈负相关(r=-0.175,P<0.01);Framingham评分低危组、中危组和高危组患者的外周血白细胞端粒长度比较,差异无统计学意义(P>0.05);外周血白细胞端粒长度与收缩压(r=0.14,P=0.04)和高密度脂蛋白胆固醇(r=0.16,P=0.03)相关,与其他心血管危险因素均无相关性(均为P>0.05)。结论 AMI患者外周血白细胞端粒长度明显降低;随着冠状动脉狭窄严重程度的增加,外周血白细胞端粒长度进一步降低。外周血白细胞端粒长度可作为AMI的预测因子,提示AMI患者的冠状动脉狭窄程度。

Objective To investigate the relationship between telomere length in peripheral blood leukocytes and severity of acute myocardial infarction （ AMI ） and traditional cardiovascular risk factors. Methods A total of 114 patients with AMI were enrolled in Xijing Hospital of Airforce Military Medical University from December 2014 to January 2017,and 117 consecutive cases of coronary stenosis 〈 50% were selected as control group during the same period. Gensini score was applied to assess the severity of coronary stenosis in enrolled patients. All subjects were divided into four groups according to the interquartile range of Gensini score. Comprehensive assessment of cardiovascular risk factors in patients was carried out using Framingham risk factor score and all subjects were divided into low risk group,midd1e risk group and high risk group. Peripheral arterial blood were collected from all patients before angiography and telomere length in peripheral blood leukocytes was detected by real-time fluorescence quantitative PCR （qPCR）. SPSS 19. 0 was used to compare telomere length differences among different groups and analyse the relationship between telomere length and different cardiovascular risk factors. Results There were significant differences in telomere length of peripheral blood leukocytes between AMI patients and controls [1.04（0. 67,1.50） vs.1.26 （0 .83,1. 67）, Z = - 2 . 4 7 ,P=0 .0 1 4 ] as well as among four groups in Gensini score（X2=7. 93,P 〈 0. 05） . Telomere length in peripheral blood leukocytes was negatively correlated with Gensini score（r =-0. 175,P 〈 0. 01 ） . There was no significant difference in peripheral blood leukocyte telomere length among low-risk group,middle risk group and high-risk group of Framingham score （ P 〉 0 .05）. Telomere length in peripheral blood leukocytes was unrelated to cardiovascular risk factors （ P 〉 0 .05）,except for systolic blood pressure （ SBP）（ r = 0 . 14, P = 0 . 04） and HDL-C （r = 0 . 16, P = 0 .0 3 ） . Conclusions The telomere length of peripheral blood leukocytes in patients with AMI was significantly decreased than that in the control group. With increase in severity of coronary stenosis,telomere length in peripheral blood leukocytes was further decreased The telomere length of peripheral blood leukocytes, indicated degree of coronary stenosis in patients with AMI,can be a predictor of AMI .