老年冠心病患者PCI术后心肌再灌注损伤与ERK/MAPK信号通路的相关性

Correlation between myocardial reperfusion injury and ERK/MAPK signaling pathway in elderly patients with coronary heart disease after PCI

目的探讨老年冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入治疗(PCI)术后心肌再灌注损伤的影响因素及与细胞外调节蛋白激酶/丝裂原活化蛋白激酶(ERK/MAPK)信号通路活化的相关性。方法选择2020年3月至2022年12月于郑州大学附属郑州中心医院心血管内科92例行PCI的老年冠心病患者作为研究对象,采用实时荧光定量PCR检测患者术前ERK、p38-MAPK mRNA的表达,评估PCI术后心肌再灌注损伤情况,分析其影响因素及与ERK/MAPK信号通路指标的关系。结果92例患者中20例(21.74%)PCI术后出现心肌再灌注损伤(损伤组,n=20)。损伤组患者PCI术前血流分级≤2级、Killip分级≥2级比例显著高于非损伤组患者,术前血清ERK、p38-MAPK mRNA表达量高于非损伤组,差异有统计学意义(P<0.05)。多因素回归分析示,术前血流分级≤2级、Killip分级≥2级及血清ERK、p38-MAPK水平升高是老年冠心病患者PCI术后出现心肌再灌注损伤的影响因素(P<0.05)。结论除血流分级、Killip分级外,术前ERK/MAPK信号通路相关指标高表达可增加老年冠心病患者PCI术后心肌再灌注损伤风险,临床应予以密切监测,以尽早识别心肌再灌注损伤并采取针对性干预措施。

Objective To investigate the influencing factors of myocardial reperfusion injury in elderly patients with coronary heart disease after percutaneous coronary intervention(PCI)and its correlation with the activation of extracellular signal-regulated kinase/mitogen-activated protein kinase(ERK/MAPK)signaling pathway.Methods Ninety-two elderly patients with coronary heart disease who underwent PCI in the Department of Cardiovascular Medicine of Zhengzhou University Affiliated Zhengzhou Central Hospital from March 2020 to December 2022 were selected as the research subjects.Real-time quantitative PCR was used to detect the expression of ERK and p38-MAPK mRNA expression in patients before surgery and assess myocardial reperfusion injury after PCI surgery.This study also analyzed the influencing factors and their relationship with the ERK/MAPK signaling pathway indicators.Results In 92 patients,20 cases(21.74%)experienced myocardial reperfusion injury after PCI surgery(injury group,n=20).The proportion of patients in the injury group with pre-PCI blood flow grade≤2 and Killip class≥2 was significantly higher than in the non-injury group.Preoperative serum levels of ERK and p38-MAPK mRNA were higher in the injury group compared to the non-injury group,with statistically significant differences(P<0.05).Multivariable regression analysis indicated that pre-PCI blood flow grade≤2,Killip class≥2,and elevated serum levels of ERK and p38-MAPK are influencing factors for myocardial reperfusion injury after PCI in elderly patients with coronary artery disease(P<0.05).Conclusion In addition to blood flow grade and Killip grade,high expression of ERK/MAPK signaling pathway before operation can increase the risk of myocardial reperfusion injury in elderly patients with coronary heart disease after PCI,suggesting close clinical monitoring to identify myocardial reperfusion injury as early as possible and take targeted intervention measures.