急性心肌梗死患者血浆vWF/ADAMTS13比值与冠状动脉病变程度的关系

Relationship between plasma vWF/ADAMTS13 ratio and severity of coronary artery lesion in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者的血管性血友病因子/血管性血友病因子裂解酶比值(vWF/ADAMTS13)与AMI患者冠状动脉(冠脉)病变严重程度的关系。方法纳入2018年4月1日至2019年3月1日在新疆维吾尔自治区人民医院心内科住院并且行冠脉造影的人群,根据是否确诊为AMI分为AMI组和对照组。采用Gensini评分评估冠脉病变严重程度,并收集患者血液样本,采用双抗体夹心酶联免疫吸附试验(ELISA)检测血浆ADAMTS13和vWF水平。根据Gensini评分将AMI患者分为Gensini评分>78分组和Gensini评分≤78分组,比较两组患者的血浆vWF和ADAMTS13水平及vWF/ADAMTS13比值,采用偏相关性分析方法分析血浆vWF/ADAMTS13比值与Gensini评分的相关性。结果共纳入266名研究对象,其中133名确诊为AMI,133名冠脉未见明显狭窄。AMI确诊患者中,65例Gensini评分>78分,68例Gensini评分≤78分。AMI组患者血浆vWF水平和vWF/ADAMTS13比值均明显高于对照组〔vWF(μg/L):261.56±134.54比172.79±88.95,vWF/ADAMTS13比值:0.38(0.23,0.68)比0.11(0.06,0.25),均P<0.05〕,血浆ADAMTS13水平明显低于对照组〔μg/L:654.23(339.58,1106.08)比1356.67(619.29,2535.91),P<0.05〕。Gensini评分>78分组患者血浆vWF/ADAMTS13比值明显高于Gensini评分≤78分组(0.58±0.46比0.42±0.29,P<0.05),而两组间血浆ADAMTS13和vWF水平比较差异均无统计学意义。偏相关分析显示,血浆vWF/ADAMTS13比值与Gensini评分呈正相关(r=0.369,P<0.001);多元线性回归分析显示,即使经过多因素校正,血浆vWF/ADAMTS13比值与Gensini评分仍呈正相关(R2=0.139,P<0.001)。结论AMI患者血浆vWF/ADAMTS13比值较正常人群显著升高,血浆vWF/ADAMTS13比值与AMI患者冠脉病变严重程度呈正相关。

Objective To investigate the relationship between the ratio of von Willebrand factor/von Willebrand factor lyase(vWF/ADAMTS13)and the severity of coronary artery lesion in patients with acute myocardial infarction(AMI).Methods Two hundred and sixty-six hospitalized patients who underwent coronary angiography in the department of cardiology in People's Hospital of Xinjiang Uygur Autonomous Region from April 1,2018 to March 1,2019 were divided into a AMI group and a control group according to the patients'definite diagnosis being AMI or not.Gensini score scale was used to evaluate the severity of coronary artery lesion,and blood samples were collected to detect plasma ADAMTS13 and vWF levels by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).According to Gensini score,AMI patients were subdivided into Gensini score>78 group and Gensini score≤78 group,and the levels of plasma vWF,plasma ADAMTS13 and vWF/ADAMTS13 ratio were compared between the two groups.Partial correlation analysis was used to analyze the correlation between plasma vWF/ADAMTS13 ratio and Gensini score.Results A total of 266 subjects were enrolled,including 133 cases with definite AMI was diagnosed,and 133 cases had no obvious coronary stenosis.Among the patients with AMI,65 cases had Gensini score>78 scores and 68 cases had Gensini score≤78.The plasma vWF level and vWF/ADAMTS13 ratio in AMI group were significantly higher than those in control group[vWF(μg/L):261.56±134.54 vs.172.79±88.95,vWF/ADAMTS13 ratio:0.38(0.23,0.68)vs.0.11(0.06,0.25),both P<0.05].The level of plasma ADAMTS13 in AMI group was significantly lower than that in the control group[μg/L:654.23(339.58,1106.08)vs.1356.67(619.29,2535.91),P<0.05].The ratio of plasma vWF/ADAMTS13 in patients with Gensini score>78 was significantly higher than that in patients with Gensini score≤78(0.58±0.46 vs.0.42±0.29,P<0.05),but the comparisons of levels of plasma ADAMTS13 and vWF in the two groups showed no statistical significant differences.The partial correlation analysis demonstrated that the ratio of plasma vWF/ADAMTS13 was positively correlated with Gensini score(r=0.395,P<0.001).Multiple linear regression analysis showed that the plasma vWF/ADAMTS13 ratio was still positively correlated with Gensini score(R2=0.136,P<0.001),even after multivariate correction.Conclusion The ratio of plasma vWF/ADAMTS13 in patients with acute myocardial infarction is significantly higher than that in normal subjects,and the ratio of plasma vWF/ADAMTS13 is correlated with the severity of coronary artery lesion in patients with AMI.