血清cathepsin S与老年人冠心病严重程度的相关性

Correlation between serum cathepsin S level and severity of coronary heart disease in elderly patients

目的观察不同类型老年冠心病患者组织蛋白酶S(cathepsin S)的表达水平,评估cathepsin S与冠心病严重程度的相关性。方法选取老年冠心病患者共126例,其中急性心肌梗死(AMI)组36例、不稳定型心绞痛(UAP)组48例、稳定型心绞痛(SAP)组42例,同时选取健康对照组40例。冠心病患者入院后即刻采集静脉血,同时AMI组行急诊冠状动脉造影者桡/股动脉鞘抽取动脉血,行冠状动脉血栓抽吸者冠状动脉内采血,行冠状动脉造影者进行SYNTAX评分。所有标本检测血清超敏C-反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)、cathepsin S水平,并比较各组间水平。结果冠心病患者血清中cathepsin S、MMP-9和hs-CRP水平显著高于对照组,其中AMI组最高,其次为UAP组,SAP组最低,差异均具有统计学意义(F=106.830、197.035、310.442,均P=0.000)。Spearman相关性分析结果显示,cathepsin S与MMP-9、hs-CRP均呈正相关(r=0.816、0.827,均P=0.000),SYNTAX评分与cathepsin S、MMP9、hs-CRP均呈正相关(r=0.581、0.511、0.557,均P=0.000)。其中24例行冠状动脉内血栓抽吸的AMI患者冠状动脉内cathepsin S、MMP-9、hs-CRP的水平明显高于外周血的水平(t=217.288、3.177、681.479,均P=0.000);且cathepsin S在外周动脉血中水平与冠状动脉内抽吸血中水平、hs-CRP在外周动脉血中水平与冠状动脉内抽吸血中水平均呈正相关(r=0.962、0.494,P=0.000、0.014),而MMP-9在外周动脉血中水平与冠状动脉内抽吸血中水平的相关性无统计学意义(r=-0.188,P=0.380)。结论老年冠心病患者血清cathepsin S水平明显高于健康人群,且随着冠心病的严重程度而增高,并与冠状动脉狭窄程度呈正相关。

Objective To study the expression level of cathepsin S in elderly patients with different degree of coronary heart disease(CHD), and to evaluate the correlation between cathepsin S level and the severity of CHD. Methods A total of 126 elderly patients with CHD were enrolled, including 36 cases with acute myocardial infarction(group AMI), 48 cases with unstable angina(group UAP), and 42 cases with stable angina(group SAP). During the same period, 40 healthy subjects were selected as controls.Venous blood was collected immediately after admission.Arterial blood was taken through radial/femoral artery sheath in AMI patients who underwent primary percutaneous coronary intervention, and coronary arterial blood was taken in AMI patients undergoing intracoronary thrombus aspiration.SYNTAX score was assessed in patients undergoing coronary angiography.Serum levels of high sensitivity C-reactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9)and cathepsin S were determined in all specimens and compared between groups. Results Serum levels of cathepsin S, MMP-9 and hs-CRP were higher in CHD patients than in the control group(P<0.05). Among CHD patients, group AMI had the highest serum levels of cathepsin S, MMP-9 and hs-CRP, followed by group UAP and group SAP(F=106.830, 197.035 and 310.442, all P=0.000). Spearman's rank correlation test suggested that cathepsin S level was positively correlated with serum levels of MMP-9(r=0.816, P=0.000)and hs-CRP(r=0.827, P=0.000). SYNTAX score was positively correlated with serum levels of cathepsin S(r=0.581, P=0.000), MMP-9(r=0.511, P=0.000), and hs-CRP(r=0.557, P=0.000). Among the 24 patients with AMI who underwent intracoronary thrombus aspiration, the levels of cathepsin S, MMP-9 and hs-CRP were higher in coronary artery blood than in peripheral artery blood(t=217.288, 3.177 and 681.479, all P=0.000). Cathepsin S and hs-CRP levels in peripheral arterial blood had positive correlations with those in coronary arterial blood respectively(r=0.962 and 0.494, P=0.000 and 0.014), but such correlation between in peripheral arterial blood versus in coronary artery blood was not found in MMP-9 levels(r=-0.188, P=0.380). Conclusions Serum cathepsin S level is higher in elderly CHD patients than in healthy people, increases along with the increased severity of CHD, and positively correlates with the degree of coronary stenosis.