脂联素对急性心肌梗死患者PGC-1α和Tfam的影响

The influence of adiponectin to PGC-1α and Tfam in in patients with acute ST segment elevation myocardial infarction

目的探讨急性ST段抬高心肌梗死(STEMI)患者循环中脂联素(APN)水平对粒体转录因子A(Tfam)和过氧化物酶体增生物激活受体γ共激活因子1α(PGC-1α)的影响。方法纳入2015年1月~2016年4月于首都医科大学附属北京友谊医院收住的急性STEMI患者160例,根据入院患者血清APN的中位数将患者随机分为低脂联素和高脂联素两组,比较两组患者临床情况、血清PGC-1α、Tfam、白介素6(IL-6)、肿瘤坏死因子-ɑ(TNF-ɑ)、冠状动脉造影分析、心肌灌注情况和临床预后。结果低脂联素组STEMI患者吸烟的比例较高(4.0%vs.52.7%,P=0.007),高脂联素组STEMI患者血清肌酐水平较低[(90.2±54.5)mmol/L vs.(76.2±17.3)mmol/L,P=0.022]。低脂联素组患者中,Gensini积分显著升高[(34.6±26.1)vs.(42.6±20.1),P<0.05]。低脂联素组患者中,Tfam和PGC-1α水平较低(P<0.01),TNF-α和IL-6水平较高(P<0.01)。结论急性STEMI患者病变较重的患者APN水平较低,血清APN较低的患者炎症因子较高,Tfam和PGC-1α因子下降。

Objective To evaluate the influence of adiponectin（APN） with the mitochondrial transcription factor A（Tfam） and peroxisome proliferator-activated receptor gamma coactivator 1 alpha（PGC-1α）. Methods160 patients with acute ST segment elevation myocardial infarction undergoing primary PCI therapy within 12 hours were enrolled. The patients were randomly divided into two groups according to the median of the admission serum APN. Serum PGC-1α, Tfam, IL 6 and TNF-ɑ level were compared. Coronary angiography, myocardial perfusion and clinical prognosis were analyzed. Results The group of lower admission serum APN had higher percentage of smoking（4.0% vs. 52.7%, P=0.007）. The serum creatinine level in myocardial infarction patients with high APN was lower（90.2±54.5 mmol/L vs. 76.2±17.3 mmol/L, P=0.022）. In hospitalized patients with low level of APN, Gensini score was significantly higher（34.6±26.1 vs. 42.6±20.1, P〈0.05）. Hospitalized patients with low level of APN were considered the lower level of Tfam and PGC-1α（P〈0.01）, the higher levels of TNF alpha and IL-6（P〈0.01）. Conclusion These results demonstrated that the patients with severe coronary artery in acute ST segment elevation myocardial infarction were founded with the lower serum adiponectin level and the lower serum adiponectin in patients responded with higher inflammatory factor, lower Tfam and PGC-1α.