急性心肌梗死患者PCI术后血浆组织蛋白酶S和血小板反应蛋白-1与心功能的关系研究

Study on the correlation between the changes of cathepsin S and platelet reactive protein-1 and cardiac function in patients with acute myocardial infarction after PCI

目的探讨急性心甩梗死(AMI)患者经皮冠状动脉介入(PCI)术后血浆组织蛋白酶S(catS)、血小板反应蛋白-1(TSP-1)对心功能的影响。方法选取2018年1月至2019年2月就诊的87例AMI患者为研究对象(AMI组),同期90例健康体检者为对照组。酶联免疫吸附(ELISA)法检测血浆catS、TSP-1表达水平,另检测各受试者B型利尿钠肽、舒张压、收缩压、左心室射血分数等心功能指标。分析AMI患者血浆catS、TSP-1表达水平与心功能指标的关系。结果AMI组高血压史、脑卒中史比例高于对照组(P<0.05)。与对照组相比,AMI患者PCI术前、术后1 d、1周血浆中catS、TSP-1、B型利尿钠肽、舒张压、收缩压升高,左心室射血分数降低(P<0.05);术后4周血浆中TSP-1、B型利尿钠肽、舒张压升高,左心室射血分数降低(P<0.05)。与PCI术前相比,AMI患者PCI术后1 d舒张压、收缩压降低,血浆中catS、TSP-1、B型利尿钠肽、左心室射血分数升高(P<0.05);术后1周、4周左心室射血分数,血浆中catS、TSP-1、B型利尿钠肽、舒张压、收缩压降低;术后4周6 min步行距离升高(P<0.05)。与AMI患者PCI术后1 d相比,术后1周、4周血浆中catS、TSP-1、B型利尿钠肽、舒张压、收缩压降低,左心室射血分数升高(P<0.05)。与PCI术后1周相比,AMI患者术后4周血浆中catS、TSP-1、B型利尿钠肽、舒张压、收缩压降低(P<0.05)。AMI患者PCI术后4周血浆中catS、TSP-1表达水平与B型利尿钠肽、catS表达水平与收缩压、TSP-1表达水平与舒张压呈正相关(P<0.05),与左心室射血分数、6 min步行距离呈负相关(P<0.05)。结论AMI患者血浆中catS、TSP-1表达水平升高,心功能指标异常;PCI术后血浆中catS、TSP-1表达水平逐渐降低,心功能指标向好发展,且血浆中catS、TSP-1表达水平与心功能指标关系密切。

Objective To investigate the effects of cathepsin S(catS)and thrombospondin-1(TSP-1)on cardiac function in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods A total of 87 patients with AMI who were treated in our hospital from January 2018 to February 2019 were enrolled as research subjects(AMI group),at the same time,the other 90 healthy subjects who underwent health examination in our hospital were enrolled as control group.The expression levels of catS and TSP-1 in plasma were detected by enzyme-linked immunosorbent assay(ELISA),heart function indexes including B-type diuretic natriuretic peptide,diastolic blood pressure,systolic blood pressure and left ventricular ejection fraction were measured.The correlation between the expressions of catS and TSP-1 in plasma and cardiac function in patients with AMI was analyzed.Results The proportion of patients with hypertension and stroke historiy in AMI group was significantly higher than that in control group(P<0.05).As compared with those in control group,the levels of catS,TSP-1,B-type diuretic natriuretic peptide,diastolic blood pressure and systolic blood pressure in plasma of patients with AMI before PCI,at 1 day and 1 week after PCI were significantly increased,however,the levels of left ventricular ejection fraction were significantly decreased(P<0.05).At 4 weeks after operation,the plasma levels of TSP-1,B-type diuretic natriuretic peptide and diastolic pressure increased and left ventricular ejection fraction in AMI group were significantly decreased(P<0.05).As compared with those before PCI,the diastolic blood pressure,systolic blood pressure in AMI group were significantly decreased at 1 day after PCI,while the expression levels of catS,TSP-1,B-diuretic natriuretic peptide and left ventricular ejection fraction were significantly increased(P<0.05).As compared with those at 1 day after PCI,the levels of plasma catS,TSP-1,B-diuretic natriuretic peptide,diastolic blood pressure and systolic blood pressure in AMI group were significantly decreased at 1w,4w after PCI,however,the levels of left ventricular ejection fraction were significantlyincreased(P<0.05).As compared with those at 1week after PCI,the levels of plasma catS,TSP-1,B-type diuretic natriuretic peptide,diastolic bloodpressure and systolic blood pressure in AMI groupwere significantly decreased at 4 weeks after PCI(P<0.05).There was a positive correlation between thelevels of catS and TSP-1 in plasma and B-diureticnatriuretic peptide,between catS expression levels and systolic blood pressure,between TSP-1 expression levels and diastolic blood pressure,however,the CatS was negatively correlated with left ventricular ejection fraction and 6-minute walking distance(P<0.05).Conclusion The expression levels of catS and TSP-1 in plasma of patients with AMI are increased and the cardiac function index is abnormal.After PCI,the expression levels of catS and TSP-1 in plasma of patients are gradually decreased,and cardiac function indexes are improved,moreover,the levels of catS,TSP-1 expression in plasma are closely related to cardiac function indexes.