急性心肌梗死患者血浆NETs水平与冠状动脉病变严重程度的关系

Relationship Between the Level of Plasma NETs and the Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients

目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者血浆中性粒细胞胞外诱捕网(neutrophil extracellular traps,NETs)主要成分瓜氨酸组蛋白3(citrulline histone 3,CitH3)、双链DNA(double-stranded DNA,dsDNA)的水平与冠状动脉(冠脉)狭窄程度的关系,及其识别冠脉病变严重程度的能力。方法收集2020年10月至2021年5月在石河子大学医学院第一附属医院住院的AMI患者95例(AMI组)及同期健康体检者95例(对照组)为研究对象,再根据Gensini评分将AMI患者分为冠脉轻度狭窄组34例(≤36分)与重度狭窄组61例(>36分)。通过酶联免疫吸附法检测受试者血浆中CitH3水平,采用PicoGreen荧光染料定量分析其血浆dsDNA水平。结果AMI患者血浆中CitH3、dsDNA水平均高于健康对照组,差异均具有统计学意义(均P<0.05)。相关性分析显示,AMI患者血浆中CitH3、dsDNA水平与Gensini评分、冠脉病变血管支数呈正相关(均P<0.05)。重度狭窄组患者血浆中CitH3、dsDNA、白细胞计数、NT-proBNP、D-二聚体、MHR水平高于轻度狭窄组,差异均具有统计学意义(均P<0.05);三支病变组、双支病变组血浆中CitH3、dsDNA水平高于单支病变组,差异均具有统计学意义(均P<0.05)。多因素Logistic回归分析显示,CitH3、dsDNA是冠脉重度狭窄的独立危险因素。受试者工作特征曲线显示,CitH3联合dsDNA对重度冠脉狭窄的预测能力明显优于CitH3、dsDNA这两个单独的指标。结论AMI患者血浆NETs水平与冠脉病变严重程度密切相关,且对冠状动脉重度狭窄具有一定的预测价值。

Objective To investigate the relationship between the expression of citrulline histone 3(CitH3)as well as double-stranded DNA(dsDNA)in plasma,which are two main components of neutrophil extracellular traps(NETs),and degree of coronary stenosis in patients with acute myocardial infarction(AMI).Methods Ninety-five patients with AMI who were hospitalized in the First Hospital Affiliated to Shihezi University from October 2020 to May 2021 were recruited in the AMI group,and another 95 healthy individuals were recruited in the control group.According to the Gensini score,AMI patients were divided into mild stenosis group(34 cases,Gensini score≤36)and severe stenosis group(61 cases,Gensini score>36).Plasma levels of CitH3 were measured by ELISA and plasma levels of dsDNA were measured by quantitative analysis with PicoGreen fluorescent dye.Results The levels of CitH3 and dsDNA in plasma of AMI patients were significantly higher than those of healthy controls(both P<0.05).Correlation analysis showed that the levels of CitH3 and dsDNA in plasma of AMI patients were positively correlated with Gensini score and the number of diseased vessels(all P<0.05).The levels of plasma CitH3,dsDNA,WBC count,NT-proBNP,D-dimer and MHR in severe stenosis group were significantly higher than those in mild stenosis group(all P<0.05).The levels of CitH3 and dsDNA in plasma of three-vessel lesion group and two-vessel lesion group were significantly higher than those of single-vessel lesion group(all P<0.05).Multivariate logistic regression analysis showed that CitH3 and dsDNA were independent risk factors for severe coronary stenosis.The operating characteristic curve showed that CitH3 combined with dsDNA was distinctly superior to independent indicators CitH3 and dsDNA in predicting severe coronary stenosis.Conclusion The level of plasma NETs in patients with AMI is closely related to the severity of coronary artery disease,and has a certain predictive value for severe coronary artery stenosis.