炎症脂肪细胞因子水平与非ST段抬高型急性冠状动脉综合征的关联性

The association between serum adipocytokines levels and non-ST segment elevation acute coronary syndrome

目的探讨血清炎症脂肪细胞因子水平与非ST段抬高型急性冠脉综合征(NSTE-ACS)及其严重程度的相关性。方法选取我院收治的急性非ST段抬高型心肌梗死和不稳定型心绞痛住院患者137例(NSTE-ACS组),纳入同期疑似冠心病但冠状动脉造影术(CAG)提示冠状动脉无明显狭窄的非冠心病患者79例(Non-CAD组)。采用酶联免疫吸附测定(ELISA)法检测血清炎症脂肪细胞因子五聚素3(PTX-3)、纤溶酶原激活物抑制剂1(PAI-1)、半乳糖凝集素3(GAL-3)、神经生长因子1(NTN1)、白细胞介素(IL)-37和脂联素(ADP)水平。利用受试者工作特征(ROC)曲线分析促炎细胞因子和抗炎细胞因子预测价值。计算冠状动脉粥样硬化评分系统(CAI)评分与炎症脂肪细胞因子的相关性,并比较不同支数冠脉病变患者血清炎症脂肪细胞因子水平的差异。结果NSTE-ACS组血清促炎因子PTX-3、PAI-1、GAL-3高于Non-CAD组,而抗炎因子NTN1、IL-37、ADP水平明显低于Non-CAD组(均P<0.01)。PTX-3、PAI-1、GAL-3、NTN1、IL-37、ADP预测NSTE-ACS的曲线下面积(AUC)分别为0.913、0.701、0.837、0.776、0.905、0.857,最佳诊断界值分别为2.95μg/L、724.5 ng/L、2.66μg/L、58.6 ng/L、103 ng/L、9.1μg/L。PTX-3、PAI-1、GAL-3与CAI评分呈正相关(rs分别为0.594、0.452、0.682,均P<0.01),NTN1、IL-37、ADP与CAI评分呈负相关(rs分别为-0.312、-0.650、-0.582,均P<0.01)。有冠脉病变患者血清促炎因子PTX-3、GAL-3水平高于无冠脉病变者,而抗炎因子NTN1、IL-37、ADP水平均明显下降。结论血清促炎脂肪细胞因子PTX-3、PAI-1、GAL-3与NSTE-ACS的严重程度呈正相关,而抗炎脂肪细胞因子NTN1、IL-37、ADP与NSTE-ACS的严重程度呈负相关,均可作为辅助NSTE-ACS临床诊断与病情评估的生物标志物。

Objective To explore the association of serum adipocytokines levels with the severity of non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods A total of 137 inpatients with non-ST-segment elevation acute myocardial infarction and unstable angina pectoris(NSTE-ACS group)were enrolled in this study.Seventy-nine inpatients underwent coronary angiography(CAG)but without coronary artery stenosis during the same period(Non-CAD group)were also included.Serum levels of adipocytokines pentraxin3(PTX-3),plasminogen activator inhibitor-1(PAI-1),galectin-3(GAL-3),netrin-1(NTN1),interleukin-37(IL-37)and adiponectin(ADP)were detected by enzyme-linked immunosorbent assay(ELISA).Receiver operating characteristic(ROC)curve was used to analyze the predictive value of pro-inflammatory cytokines and anti-inflammatory cytokines.The relationship between coronary atherosclerosis index(CAI)score and adipocytokines was assessed.The difference of serum adipocytokines levels in patients with the different number of stenotic coronary arteries was also compared.Results The serum levels of pro-inflammatory adipocytokines PTX-3,PAI-1 and GAL-3 were significantly higher in NSTE-ACS group than those in Non-CAD group,while the serum levels of anti-inflammatory adipocytokines NTN1,IL-37 and ADP were significantly lower in NSTE-ACS group than those in Non-CAD group(all P<0.01).The PTX-3(rs=0.594),PAI-1(rs=0.452),GAL-3(rs=0.682)were positively correlated with CAI scores.The NTN1(rs=-0.312),IL-37(rs=-0.650)and ADP(rs=-0.582)were negatively correlated with CAI scores(all P<0.05).The AUC of PTX-3,PAI-1,GAL-3,NTN1,IL-37 and ADP to predict NSTE-ACS were 0.913,0.701,0.837,0.776,0.905 and 0.857,respectively,and the best diagnostic cutoff values were 2.95μg/L,724.5 ng/L,2.66μg/L,58.6 ng/L,103 ng/L and 9.1μg/L respectively.In the NSTE-ACS group,the serum levels of PTX-3,PAI-1 and GAL-3 were increased with the increased numbers of stenotic coronary arteries,but the NTN1,IL-37 and ADP levels were decreased(all P<0.01).Conclusion Serum pro-inflammatory adipocytokines including PTX-3,PAI-1 and GAL-3 are positively correlated with the severity of NSTE-ACS,while the anti-inflammatory adipocytokines,NTN1,IL-37 and ADP are negatively correlated with the severity of NSTE-ACS.All the above adipocytokines can be used as biomarkers for the clinical diagnosis and the severity assessment of NSTE-ACS.