脂肪因子Vaspin表达在急性冠脉综合征诊断及预后评估中的作用

The role of Vaspin expression in the diagnostic and prognostic evaluation of acute coronary syndrome

目的:测定内脏脂肪特异性丝氨酸蛋白酶抑制剂(vaspin)、心肌肌钙蛋白T(cardiac troponin T,cTnT)以及B型尿钠肽前体(N-terminal pro-brain natriuretic peptide,NT-pro-BNP)在急性冠脉综合征组(acute coronary syndrome,ACS)、稳定性冠心病组和对照组中的表达水平,比较它们在各组的差异,为ACS临床诊断及预后评估提供新依据。方法:随机选取经冠状动脉造影术诊断明确ACS 158例,稳定性冠心病80例,非冠心病90例(对照组)。通过酶联免疫吸附实验法检测入组患者血清Vaspin浓度,同时检测cTnT和NT-pro-BNP的表达水平。采用单因素方差分析法比较ACS组、稳定性冠心病组和对照组之间Vaspin、cTnT、NT-pro-BNP的表达水平差异。随访术后2年内心源性死亡、心源性再入院以及再血管化治疗的发生情况,采用多因素Logistic回归分析法评估Vaspin表达水平与心血管不良预后的差异,最终综合评价Vaspin表达水平在ACS早期诊断及预后评估中的作用。结果:Vaspin表达:ACS组<稳定性冠心病组<对照组,差异具有统计学意义(P <0.01);cTnT表达:ACS组>稳定性冠心病组>对照组,差异具有统计学意义(P <0.01);NT-pro-BNP表达:ACS组>稳定性冠心病组>对照组,差异具有统计学意义(P <0.01)。Vaspin浓度与NT-pro-BNP和cTnT的水平呈显著负相关。Vaspin表达水平越低,发生心源性死亡、心源性再入院以及再血管化等不良事件的风险越高。结论:Vaspin在ACS中的表达水平显著低于稳定性冠心病和非冠心病患者,且与NT-pro-BNP和cTnT呈负相关。Vaspin是ACS的独立危险因素,Vaspin的表达水平越低则患者冠心病程度越重且预后越差。

Objective:Observing the expression of visceral fat-specific serine protease inhibitor(Vaspin),cardiac troponin T(cTnT and N-terminal pro-brain natriuretic peptide(NT-pro-BNP)in acute coronary syndrome(ACS),stable coronary heart disease and control to provide new basis of Vaspin for clinical diagnostic and prognostic evaluation of ACS. Methods:A total of 158 patients with ACS,80 patients with stable coronary heart disease and 90 patients without coronary heart disease were included. The expression of Vaspin was detected by enzyme-linked immunosorbent assay,while the levels of cTnT and NT-pro-BNP were detected at the same time. The expression levels of Vaspin,cTnT and NT-pro-BNP were analyzed and compared in three groups by one-way ANOVA. A 2-year follow-up of clinical outcomes including cardiac death,rehospitalization and revascularization was conducted and logistic analysis was used to evaluate the relationship between Vaspin level and clinical prognosis. Results:The results showed significant difference of Vaspin,cTnT and NT-pro-BNP among three groups(P < 0.01). The expression level of Vaspin was lowest in ACS group and highest in control group,while the expression level of cTnT and NT-pro-BNP were highest in ACS group and lowest in control group. There was significant negative correlations between Vaspin and NT-pro-BNP or cTnT. Furthermore,lower expression level of Vaspin indicated higher risk of cardiovascular adverse events,such as cardiac death,rehospitalization and revascularization. Conclusion:The expression level of Vaspin in ACS was significantly lower than that in stable and non-coronary heart disease,which was negatively correlated with NT-pro-BNP and cTnT. Vaspin is an independent risk factor for ACS,and the lower expression level of Vaspin,the worse prognosis of patients.