稳定型冠心病合并肥胖患者血清Ghrelin nesfatin-1 Obestatin的临床意义

Clinical Significance of Serum Ghrelin,Nesfatin-1 and Obestatin in Patients with Stable Coronary Heart Disease and Obesity

目的:探究稳定型冠心病合并肥胖患者血清胃饥饿素(Ghrelin)、人新饱食分子蛋白1(nesfatin-1)、肥胖抑制素(Obestatin)的表达水平及临床意义。方法:选取2018年9月至2020年8月北京朝阳急诊抢救中心收治的206例稳定型冠心病患者为研究对象,依据《中国成人超重和肥胖症预防控制指南》将研究对象分为正常组(87例)、超重组(72例)、肥胖组(47例),检测高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、三酰甘油(TG)、空腹血糖(FBG)水平,采用酶联免疫吸附法(ELISA)检测血清Ghrelin、nesfatin-1、Obestatin水平并进行组间比较;收集患者基本资料;对患者进行冠状动脉造影检查并计算SYNTAX积分;采用Spearman分析血清Ghrelin、nesfatin-1水平与SYNTAX积分相关性;采用Logistic回归模型分析影响稳定型冠心病患者病情严重程度的因素。结果:正常组、超重组、肥胖组体质量指数(BMI)、LDL-C、TC、SYNTAX积分呈升高趋势(P<0.05),HDL-C、血清Ghrelin、nesfatin-1水平呈降低趋势(P<0.05),血清Obestatin水平差异无统计学意义(P>0.05),三组病变支数差异有统计学意义(P<0.05);Spearman分析结果显示,血清Ghrelin、nesfatin-1水平与SYNTAX积分均呈负相关(r=-0.532,P=0.000;r=-0.630,P=0.000);多因素Logistic回归分析结果显示,BMI、LDL-C、TC均是影响稳定型冠心病患者发生重度病变的独立危险因素(P<0.05),Ghrelin、nesfatin-1是影响稳定型冠心病患者发生重度病变的保护因素(P<0.05)。结论:稳定型冠心病合并肥胖患者血清Ghrelin、nesfatin-1表达水平与稳定型冠心病患者病情严重程度密切相关,可能成为评估病情的生物学辅助指标。

Objective:To investigate the expression levels and significance of serum Ghrelin,nesfatin-1 and Obestatin in patients with stable coronary heart disease complicated with obesity.Methods:A total of 206 patients with stable coronary heart disease(CHD)admitted to Beijing Chaoyang emergency rescue center from September 2018 to August 2020 were selected and divided into normal group(87 cases),overweight group(72 cases)and obesity group(47 cases)according to the Guidelines for Prevention and Control of Overweight and Obesity in Chinese adults,the levels of high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglyceride(TG)and fasting blood glucose(FBG)were measured,the serum levels of Ghrelin,nesfatin-1 and Obestatin were detected by enzyme-linked immunosorbent assay(ELISA);the basic data of patients were collected;coronary angiography was performed and SYNTAX score was calculated;Spearman was used to analyze the correlation between serum Ghrelin,nesfatin-1 levels and SYNTAX score;Logistic regression model was used to analyze the factors influencing the severity of stable coronary heart disease.Results:The BMI,LDL-C,TC and syntac of the normal group,the hyperrecombination group and the obesity group were increased(P<0.05).HDL-C,ghrelin and nesfatin-1 were decreased(P<0.05),and the serum obestatin levels were not statistically significant(P>0.05).And the difference of the number of pathological changes in the three groups was statistically significant(P<0.05).Spearman analysis showed that serum ghrelin and nesfatin-1 levels were negatively correlated with syntax score(r=-0.532,P=0.000;r=-0.630,P=0.000).Multivariate logistic regression analysis showed that BMI,LDL-C and TC were independent risk factors for severe lesions in patients with stable coronary heart disease(P<0.05).Ghrelin and nesfatin-1 were protective factors for severe lesions in patients with stable coronary heart disease(P<0.05).Conclusion:The expression levels of serum Ghrelin and nesfatin-1 in patients with stable coronary heart disease and obesity are closely related to the severity of the disease in patients with stable coronary heart disease,and may become biological auxiliary indicators for evaluating the condition.