NETRIN-1在急性心肌梗死缺血再灌注期间的水平变化及意义

Changes and significance of NETRIN-1 level in acute myocardial infarction during ischemia-reperfusion

目的探讨神经生长向导因子(NETRIN-1)在急性心肌梗死缺血再灌注期间的水平变化及意义。方法选择2018年3月—2020年3月本院收治的60例急性心肌梗死患者作为疾病组,根据治疗情况将疾病组患者分为急诊经皮冠状动脉介入治疗(PCI)组32例、择期PCI组28例;选取同期60例体检健康者作为健康组。比较健康组和疾病组患者手术前血清NETRIN-1水平,急诊PCI组患者手术前、手术后即刻、6 h、12 h和24 h血清NETRIN-1动态变化情况;分析疾病组患者血清NETRIN-1水平与冠脉病变程度相关性。结果疾病组术前血清NETRIN-1为(683.58±78.24)mg/ml高于健康组(426.76±66.72)mg/ml,差异有统计学意义(t=17.840,P=0.000);急诊PCI组患者手术后即刻NETRIN-1水平高于手术前,术后12 h、24 h的NETRIN-1水平均低于手术前,差异有统计学意义(P<0.05);手术后6 h患者NETRIN-1水平与手术前比较,差异无统计学意义(P>0.05);急诊PCI组Gensini评分、NETRIN-1水平均低于择期PCI组,差异有统计学意义(P<0.05);经Spearman相关分析,急诊PCI组患者、择期PCI组术前血清NETRIN-1水平与Gensini评分呈正相关(r=0.438、0.347,P=0.000、0.010)。结论在急性心肌梗死患者体内NETRIN-1水平明显上升,并与冠脉病变程度相关,PCI术后即刻NETRIN-1水平继续升高,术后6 h恢复术前水平,术后12 h持续降低并保持,NETRIN-1对急性心肌梗死早期诊断及术后评估均有重要意义。

Objective To explore the changes and significance of nerve growth guidance factor(NETRIN-1)in acute myocardial infarction(AMI)during ischemia-reperfusion(IR).Methods During the period from March 2018 to March 2020,60 AMI patients who were admitted to the hospital were enrolled as disease group.According to different treatment situations,patients in disease group were divided into emergency percutaneous coronary intervention(PCI)group(32 cases)and elective PCI group(28 cases).Another 60 healthy controls in the same period were enrolled as health group.The level of serum NETRIN-1 before surgery between healthy group and disease group,and dynamic changes of serum NETRIN-1 level in emergency PCI group before surgery,immediately after surgery,at 6 h,12 h and 24 h were compared.Correlation between level of NETRIN-1 in serumand coronary lesions severity in disease group was analyzed.Results Before surgery,level of serum NETRIN-1 in disease group was higher than that in healthy group[(683.58±78.24)mg/m L vs(426.76±66.72)mg/m L](t=17.840,P=0.000).In emergency PCI group,level of NETRIN-1 immediately after surgery was higher than that before surgery,while level of NETRIN-1 at 12 h and 24 h after surgery was lower than that before surgery(P<0.05).There was no significant difference in level of NETRIN-1 at 6 h after surgery and before surgery(P>0.05).Gensini score and NETRIN-1 level in emergency PCI group were lower than those in elective PCI group(P<0.05).Spearman correlation analysis showed that in emergency PCI group and elective PCI group,preoperative level of serum NETRIN-1 was positively correlated with Gensini score(r=0.438,0.347,P=0.000,0.010).Conclusions The level of NETRIN-1 is significantly increased in AMI patients,which is related to coronary lesions severity.Immediately after PCI,level of NETRIN-1 continues to increase,returning to the preoperative level at 6 h after surgery,continuing to decrease and maintaining the same at 12 h after surgery.NETRIN-1 is of great significance for early diagnosis and postoperative evaluation of AMI.