急性冠状动脉综合征患者血浆sRAGE、IFN-γ浓度及其与冠状动脉病变严重程度的关系

Levels of sRAGE and IFN-γin the plasma of patients with acute coronary syndrome and their relationship with the severity of coronary artery lesions

目的 探讨不同类型急性冠状动脉综合征患者血浆中可溶性晚期糖基化终末产物受体(soluble receptor for advanced glycation end product,sRAGE)、γ-干扰素(interferon-γ,IFN-γ)浓度及其与冠状动脉病变严重程度的关系。方法 纳入2016年6月至2018年6月于首都医科大学附属北京天坛医院行冠状动脉造影的236例患者,分为急性心肌梗死组(n=42)、不稳定型心绞痛组(n=119)、非冠状动脉粥样硬化性心脏病(以下简称冠心病)组(n=75)。用酶联免疫法检测各组血浆中sRAGE和IFN-γ浓度并比较。分别分析急性心肌梗死患者、不稳定型心绞痛患者sRAGE、IFN-γ在不同Gensini评分分组中的差异及其与冠状动脉病变支数的相关性。分析急性心肌梗死患者sRAGE、IFN-γ与心肌梗死标志物心肌肌钙蛋白(cardiac troponin I,cTnI)、肌红蛋白(myoglobin,Myo)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)的相关性。结果 急性心肌梗死组患者sRAGE浓度最高,非冠心病组最低。急性心肌梗死组IFN-γ浓度高于不稳定型心绞痛组和非冠心病组,不稳定型心绞痛组和非冠心病组差异无统计学意义。多因素Logistics回归分析显示sRAGE浓度升高是急性心肌梗死和不稳定型心绞痛的独立危险因素,且与急性心肌梗死的关系更为密切。急性心肌梗死患者血浆中sRAGE与IFN-γ浓度呈正相关,两者均与心肌梗死标志物cTnI、Myo、CK-MB呈正相关,与Gensini评分、冠状动脉病变支数未见明显相关性。不稳定型心绞痛患者,高Gensini组sRAGE及IFN-γ浓度大于中Gensini组和低Gensini组,sRAGE浓度以三支病变组最高、单支病变组最低,IFN-γ浓度以双支病变组最高、单支病变组最低。结论 急性冠状动脉综合征患者血浆中sRAGE浓度明显升高,并且急性心肌梗死者高于不稳定型心绞痛患者。不稳定型心绞痛患者中sRAGE及IFN-γ浓度与冠状动脉病变严重程度呈正相关。

Objective To investigate the plasma levels of soluble receptor for advanced glycation end product(sRAGE)and interferon-γ(IFN-γ)in patients with different types of acute coronary syndromes and their relationship with the severity of coronary artery lesions.Methods A total of 236 patients who underwent coronary angiography in Beijing Tiantan Hospital,Capital Medical University from June 2016 to June 2018 were included and divided into acute myocardial infarction group(n=42),unstable angina pectoris group(n=119),non-(coronary heart disease,CHD)group(n=75).The levels of sRAGE and IFN-γin the plasma of each group were detected and compared by enzyme-linked immunosorbent assay.The differences of sRAGE and IFN-γin patients with acute myocardial infarction and unstable angina pectoris in different Gensini score groups and their correlation with the number of coronary artery lesions were analyzed,respectively.The correlations between sRAGE and IFN-γand myocardial infarction markers cardiac troponin I(cTnI),myoglobin(Myo)and creatine kinase isoenzyme(CK-MB)in patients with acute myocardial infarction were analyzed.Results The sRAGE level was the highest in the acute myocardial infarction group and the lowest in the non-coronary heart disease group.The level of IFN-γin the acute myocardial infarction group was higher than that in the unstable angina pectoris group and the non-coronary heart disease group,and there was no significant difference between the unstable angina pectoris group and the non-coronary heart disease group.Multivariate Logistic regression analysis showed that elevated sRAGE level was an independent risk factor for acute myocardial infarction and unstable angina,and was more closely related to acute myocardial infarction.In patients with acute myocardial infarction,sRAGE and IFN-γwere positively correlated,and both were positively correlated with myocardial infarction markers cTnI,Myo,and CK-MB,but had no significant correlation with Gensini score and the number of coronary artery lesions.In unstable angina pectoris,the levels of sRAGE and IFN-γin the high GS group were higher than those in the medium Gensini group and the low Gensini group.The sRAGE level was the highest in the three-vessel disease group and the lowest in the single-vessel disease group,and the IFN-γlevel was the highest in the double-vessel disease group and the lowest in the single-vessel disease group.Conclusion The level of sRAGE in the plasma of patients with acute coronary syndrome is significantly increased,and the level of sRAGE in patients with acute myocardial infarction is higher than that in patients with unstable angina pectoris.The levels of sRAGE and IFN-γin unstable angina pectoris were positively correlated with the severity of coronary artery disease.