细胞因子和血管活性物质与心肌梗死预后相关性分析

Analysis of correlation of cytokines and vasoactive substances with prognosis of myocardial infarction

目的探讨急性心肌梗死患者血清中细胞因子(血管内皮生长因子B、白细胞介素-32)和血管活性物质(蛋白相关磷脂酶A2、儿茶酚抑素)与急性心肌梗死预后相关性。方法收集我院急性冠脉综合征患者294例,其中急性心肌梗死(AM I)189例,不稳定型心绞痛(UA)105例,记录两组患者一般情况并测定血清中VEGF-B、Lp-PLA2、CST、IL-32水平变化,同时评估AMI组患者各期心功能指标,对AMI患者随访6个月,记录发生心脏主要不良事件情况,探讨上述4种生化指标与AMI预后关系。结果治疗前,两组患者血清VEGF-B比较差异无统计学意义(P>0.05),AMI组Lp-PLA2、CST高于UA组(P<0.05),IL-32低于UA组(P<0.05);治疗后,两组患者上述指标比较差异无统计学意义(P>0.05)。心功能各期对比显示,VEGF-B在KiliipⅠ~Ⅳ期差异无统计学意义(P>0.05);Lp-PLA2、CST水平在各组间随着心功能恶化呈上升趋势;IL-32含量随心功能恶化而降低。随访终止时,AMI患者总MACE发生率为42.33%。预后不良组患者入院时血清中VEGF-B、IL-32低于预后良好组(P<0.05),Lp-PLA2、CST高于预后良好组(P<0.05)。结论发生AMI与UA时,CST、LpPLA2水平升高提示预后不良,VEGF-B、IL-32与预后MACE发生率呈负相关。

Objective To investigate the correlation of serum cytokines（ vascular endothelial growth factor B and interleukin-32） and vasoactive substances（ protein-related phospholipase A2 and catestatin） with the prognosis of patients with acute myocardial infarction. Methods Totally 294 cases of acute coronary syndrome in our hospital were collected,including 189 cases of AMI and 105 cases of UA. The general condition was recorded and the levels of serum VEGF-B,Lp-PLA2,CST and IL-32 were detected,meanwhile,the index of heart function of AMI patients was assessed,and the occurrence of major adverse cardiac events were followed up for 6 months. The relationship between levels of VEGF-B,Lp-PLA2,CST and IL-32 and the prognosis of AMI was investigated. Results Before treatment,there was no significant difference in serum VEGF-B between the two groups（ P〉0. 05）; the levels of Lp-PLA2 and CST in AMI group were higher than those of UA group（ P〈0. 05）,while the level of IL-32 was lower（ P〈0. 05）.There was no significant difference in the above indexes between the two groups after treatment（ P〈0. 05）. No significant difference was found in the VEGF-B among groups with KiliipⅠ - Ⅳ（ P〈0. 05）; the levels of Lp-PLA2 and CST showed an upward trend along with the deterioration of cardiac function,meanwhile,the content of IL-32 was reduced.At the end of follow-up,the incidence of total MACE in patients with AMI was 42. 33%. The serum levels of VEGF-B and IL-32 in patients with poor prognosis were lower than those of good prognosis group（ P〈0. 05）,and contents of Lp-PLA2 and CST were higher（ P〈0. 05）. Conclusion High levels of CST and Lp-PLA2 indicate the poor prognosis of patients with AMI and UA,while the levels of VEGF-B and IL-32 were negatively correlated with the prognosis of MACE.