行直接PCI的急性ST段抬高型心肌梗死患者血清糖基化终末产物的水平研究

Study on plasma advanced glycation end products in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

目的 观察行直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者不同时间点的血清糖基化终末产物(AGEs)水平,以及在不同糖代谢状态下(糖代谢正常组和糖尿病组)的变化。方法 采用前瞻性研究方法,连续入选2014年12月至2015年12月于首都医科大学附属北京友谊医院心内科住院,首次诊断STEMI并接受直接PCI治疗的患者共151例,分别于3个不同时间点采集空腹静脉血(包括入院即刻、第2天、第5天),测定血清AGEs水平,并连续测定心肌酶谱(CK-MB、c TNI、c TNT)及N-端前体脑钠肽(NT-pro BNP)水平,非糖尿病患者入院后5~7 d行口服葡萄糖耐量试验(OGTT)进行糖代谢分组,分为血糖调节正常组37例,血糖调节异常组37例,新诊断糖尿病组35例,既往糖尿病组42例。同时入选对照组40例,均经影像学检查证实冠状动脉狭窄<50%,包括糖代谢正常患者20例和糖尿病患者20例,均测定血清AGEs水平。结果 行直接PCI的151例STEMI患者,114例(75. 5%)合并糖代谢异常。STEMI患者48 h AGEs水平较入院即刻有显著下降(288. 16±63. 76) ng/ml vs.(307. 67±57. 40) ng/ml,P=0. 002);5 d AGEs水平与48 h相比有显著回升(307. 71±70. 80) ng/ml vs.(288. 16±63. 76) ng/ml,P=0. 001)。不论是否合并糖尿病,STEMI患者入院血清AGEs水平均显著高于对照组[糖尿病组:(318. 81±59. 62) ng/ml vs.(268. 72±42. 58) ng/ml,P=0. 001;糖代谢正常组:(288. 00±38. 24) ng/ml vs.(242. 76±32. 17) ng/ml,P=0. 002]。STEMI患者中,与糖代谢正常组相比,合并糖尿病组不同时间点血清AGEs水平均显著升高。STEMI患者入院即刻血清AGEs水平与肌酸激酶同工酶(CK-MB)峰值呈正相关(r=0. 211,P=0. 009);而STEMI患者中DM组入院即刻血清AGEs水平与NT-pro BNP峰值呈正相关(r=0. 246,P=0. 031)。结论 直接接受PCI的STEMI患者的血清AGEs水平明显升高,尤其是糖尿病患者。血清AGEs水平与心肌损伤标志物CK-MB峰值呈正相关,DM组与NT-pro BNP峰值呈正相关,可能成为STEMI患者新的影响预后的生物标志物。

Objective To study plasma advanced glycation end products levels in patients with and without ST-segment elevation myocardial infarction(STEMI),as well as with and without diabetes.Methods A prospective observational study was performed between December 2014 and December 2015 at Department of Cardiology,Beijing Friendship Hospital,Capital Medical University.Study group included 151 STEMI patients with coronary artery disease.Patient's diabetic status was determined by medical history or oral glucose tolerance test.Levels of AGEs were tested on before primary PCI,48 h and 5 d,venous samples were obtained to measure AGEs.Levels of creatine kinase-MB(CK-MB),cardiac troponin I,and N-terminal pro-brain natriuretic peptide(NT-proBNP)were tested on Days 0,1,2,and 3.At the same time coronary angiography or coronary CTA results negative 40 cases were included as control group,including diabetes control group 20 cases,without diabetes control group 20 patients.Results Of 151 STEMI patients who underwent primary PCI,114(75.5%)had abnormal glucose metabolism.Levels of AGEs declined at Day 2,and then increased again at Day 5.Compared with patients in the control group,STEMI patients showed elevated levels of AGEs.In the STEMI group,diabetic patients had higher levels of AGEs compared to non-diabetic patients.The level of AGEs correlated with peak level of CK-MB in the overall population of patients with STEMI and with peak level of NT-proBNP in diabetic patients with STEMI.Conclusion Levels of AGEs were elevated after STEMI,especially among patients with diabetes.AGEs may be associated with indicators of myocardial injury and cardiac insufficiency after myocardial infarction,become the new biomarkers affecting the prognosis.