补体C1q肿瘤坏死因子相关蛋白3与急性冠脉综合征的关系

目的 研究补体C1q肿瘤坏死因子相关蛋白3（C1q tumor necrosis factor related proteins-3,CTRP3）在急性冠脉综合征(acute coronary syndrome,ACS)患者中的表达及作用。方法 检测ACS患者206例和稳定型心绞痛（stable angina pectoris,SAP）患者208例血浆中CTRP3。结果 与SAP相比,ACS患者血浆CTRP3和脂联素（adiponectin,APN）显著降低（P<0.01）。校正年龄和性别后,CTRP3与血糖(r=-0.121,P<0.01),高敏C反应蛋白(high sensitive C-reactive protein,hsCRP)(r=-0.152,P<0.01)负相关。与高密度脂蛋白胆固醇(r=0.112,P<0.01)和脂联素(r=0.136,P<0.01)正相关。多因素logistic回归分析发现:与高三分位数CTRP3组相比,中三分位数CTRP3组OR值5.08（95%可信区间,1.69-13.43）,低三分位数OR值8.17（95%可信区间,2.36-28.36）。结论 CTRP3与ACS有关联。     

冠心病患者血清TGF-β1与TNF-α的相关性

目的探讨血清转化生长因子(TGF)-β1和肿瘤坏死因子(TNF)-α的水平变化对冠心病(CHD)患者心功能的影响。方法采用酶联免疫吸附法(ELISA)测定患者及对照组的血清TGF-β1、TNF-α水平。结果对照组TGF-β1水平显著高于稳定型心绞痛(SAP)组、不稳定型心绞痛(UA)组和急性心肌梗死(AMI)组(P<0.01),且SAP组TGF-β1水平显著高于UA组和AMI组;SAP组、UA组和AMI组TNF-α水平显著高于对照组(P<0.01),且UA组和AMI组TNF-α水平显著高于SAP组。CHD患者血清TNF-α水平与TGF-β1呈负相关(r=-0.746)。结论血清TGF-β1和TNF-α参与冠状动脉粥样硬化的发生发展过程,TGF-β1和TNF-α在CHD的发病机制中互为影响。     

新脂肪细胞因子CTRP9的研究进展

C1q/肿瘤坏死因子相关蛋白9(C1q/TNF-related protein 9,CTRP9)是一种新发现的与脂联素高度同源的脂肪细胞因子,其对机体具有正性作用,在调节代谢、保护心肌、舒张血管和改善内皮功能等方面发挥重要作用。本文对CTRP9的分子结构、聚合形式、组织表达和分泌以及生物学功能作一综述。     

CTRP家族在代谢相关性疾病中的作用

补体C1q/肿瘤坏死因子相关蛋白(complement-C1q/tumor necrosis factor-related protein,CTRP)家族是一类主要由脂肪组织分泌的脂肪因子超家族,结构特征相似,具有抗炎、胰岛素增敏、调节代谢和免疫等生物学功能。目前已经发现的CTRP家族成员包括CTRP1~15。研究发现CTRP家族与代谢相关疾病如糖尿病、肥胖、冠心病等密切相关。     

血清CTRP9水平与冠心病的关系

目的：探讨血清补体C1q肿瘤坏死因子相关蛋白9（CTRP9）表达水平与冠心病的关系。方法：入选经冠状动脉造影证实的稳定型冠心病患者278例（冠心病组）和113例健康对照（对照组）,采用酶联免疫吸附法（ELISA）检测血清中CTRP9的水平。结果：冠心病组CTRP9水平明显低于对照组（P〈0．05）;多元逻辑回归分析发现,CTRP9降低是冠心病的独立危险因素。结论：血清CTRP9水平降低与冠心病发生有关,CTRP1降低是冠心病的独立危险因素。     

CTRP9对心血管保护作用的研究进展

补体1q肿瘤坏死因子相关蛋白（CTRP）9是CTRP蛋白家族重要成员，与脂联素高度同源，结构相似。近几年发现CTRP9在动脉粥样硬化、缺血性心脏病（IHD）等心血管疾病中作用广泛。除了经典的调节糖脂代谢、调节内皮功能外，最近的研究显示外源性补充CTRP9能够对缺血心肌发挥保护作用，而且CTRP9在心脏局部特异性高表达，可能是一种重要的心脏因子，参与调节心肌局部微环境，发挥心肌保护作用，本文将就CTRP9在心血管保护方面的研究进展进行综述。     

冠心病患者侧支循环程度与血浆补体C1q肿瘤坏死因子相关蛋白及胰岛素抵抗的相关性研究

目的:检测不同侧支循环的冠心病患者补体C1q肿瘤坏死因子相关蛋白(CTRP1)的表达水平,探讨CTRP1表达水平与侧支循环程度、疾病严重程度及胰岛素抵抗的相关性。方法:选择82例在本院心内科进行选择性冠状动脉造影的患者,分析其侧支循环的形成情况。依据造影结果,以Rentrop评级标准评判患者的侧支循环,将患者分为:侧支循环不良组(CCB)47例;侧支循环良好组(CCW)35例。冠状动脉造影排除冠心病的患者为对照组(NC)37例;以Gensini计分方法评价冠状动脉病变的严重程度。分别检测各组患者血浆CTRP1表达水平,空腹血糖(FBG),空腹胰岛素(FINS),白细胞介素-6(IL-6),以及各组患者的临床资料,包括:TG,TC,HDL-C,LDL-C,计算胰岛素抵抗指数(HOMA-IR)等。检测Rentrop分级、Gensini评分和CTRP1表达水平与各指标的相关性,及以CTRP1为因变量分析其危险因素。结果:CCB组,CCW组与NC组比较,各检测指标均差异有统计学意义(P0.05);Rentrop分级与血浆CTRP1表达水平,FBG,HOMA-IR,TG,IL-6及Gensini评分负相关,差异有统计学意义(P0.05);Gensini评分与CTRP1,FBG,HOMA-IR,TG,IL-6呈正相关,差异有统计学意义(P0.05);血浆CTRP1表达水平与TC,HOMA-IR,IL-6呈正相关,差异有统计学意义(P0.05);采用多元逐步回归分析CTRP1表达水平的危险因素为HOMA-IR,IL-6,差异有统计学意义(P0.05)。结论:冠心病患者血浆CTRP1表达水平与侧支循环程度以及胰岛素抵抗相关。     

补体C1q肿瘤坏死因子相关蛋白1与脂联素水平的关系

目的探讨健康老年人、2型糖尿病(T2DM)老年患者、T2DM合并冠心病(CHD)老年患者及CHD老年患者补体C1q肿瘤坏死因子(TNF)相关蛋白1(CTRP1)与脂联素(ADPN)水平及其关系。方法采用酶联免疫法(ELISA)测定各组患者血清CTRP1及ADPN的水平。将患者分为对照组(n=42);T2DM组(n=30);并发症组(n=32);CHD组(n=31);定义对照组、CHD组为非糖尿病(DM)组;T2DM组、并发症组为DM组。结果 DM组血清CTRP1水平明显高于非DM组。DM组CTRP1水平与ADPN水平呈负相关关系。结论 CTRP1与T2DM有关。本实验结果支持目前关于CTRP1为ADPN有效补充的观点。     

阿托伐他汀对ACS患者血清CTRP9的影响及其机制的研究

目的 探讨ACS患者血清脂肪细胞因子C1q/肿瘤坏死因子相关蛋白 9（CTRP9）与疾病的关系,并观察使用阿托伐他汀治疗后血清CTRP9水平的变化及可能的机制。 方法 选择102例ACS患者和70名正常对照者,检测2组血清CTRP9水平。再将102例ACS患者随机分为常规治疗组51例（M组）和阿托伐他汀组51例（A组）,后者在常规治疗基础上,加服阿托伐他汀20mg/d,治疗8周后观察2组患者血清CTRP9水平。并用ELISA法检测A、M组治疗前后的血清游离脂肪酸（FFA）、氧化低密度脂蛋白（ox-LDL）水平。 结果 与正常对照组相比,ACS患者血清 CTRP9水平显著降低（P＜0.05）,Logistic 回归分析表明,血清CTRP9是ACS患者的独立保护因子。与M组相比,治疗8周后,A组血清 CTRP9水平显著升高（P＜0.05）,血清FFA、ox-LDL水平明显下降（P＜0.05）,而M组血清 CTRP9、FFA、ox-LDL治疗前后表达水平无明显变化。 结论 ACS患者血清 CTRP9水平明显降低,CTRP9是ACS独立的保护因素,阿托伐他汀可升高ACS血清CTRP9 水平,其机制可能与下调血清FFA、ox-LDL有关。     

脂肪因子CTRP3的认识及研究现状

CTRP3是C1q肿瘤坏死因子相关蛋白家族中的一员,是新发现的脂肪因子。研究发现CTRP3在抗炎、代谢调控及减轻缺血损伤等方面发挥重要作用。本文就CTRP3的分子结构、表达、含量以及生物功能做一综述。     

急性冠状动脉综合征患者早期血清胆红素水平的变化

目的观察急性冠状动脉综合征(ACS)患者早期血清胆红素水平的动态变化并探讨其临床意义。方法选择稳定型心绞痛(SAP)患者28例,发病在24h内的ACS患者88例,包括不稳定性心绞痛(UAP)36例和急性心肌梗死(AMI)52例。测定其血清总胆红素(Tbil)、直接胆红素 (Dbil)和间接胆红素(Ibil)水平,并与40例健康人进行对照比较。ACS患者于发病第7天和第14天时分别复查上述指标。结果 SAP患者其血清Tbil和Ibil均显著低于对照组(P<0．05);而ACS患者无论是UAP还是AMI,其Tbil和Ibil均明显高于对照组(P<0．05),ACS患者发病第7天即显著下降(P<0．05),第14天时又有进一步降低。而Dbil水平在各组间均无显著性差异(P>0．05)。结论 ACS患者在发病后其Tbil和Ibil水平明显升高,发病7-14天后即显著降低。Tbil和Ibil水平的升高可能与斑块活化、不稳定有关。     

Plasma levels of Elabela are associated with coronary angiographic severity in patients with acute coronary syndrome

BackgroundElabela (ELA) was newly discovered as a novel endogenous ligand of the apelin receptor (APJ) which has demonstrated to be crucial for cardiovascular disease such as myocardial infarction, hypertension and heart failure. Previous experiments have revealed that ELA reduced arterial pressure and exerted positive inotropic effects on the heart. However, the role of plasma ELA levels in patients with acute coronary syndrome (ACS) and its relationship with severity of coronary arteries have not been investigated.MethodsTwo hundred and one subjects who were hospitalized for chest pain and underwent coronary angiography were recruited in this study. One hundred and seventy five patients were diagnosed with ACS and twenty-six subjects with negative coronary angiography were included in the control group. Plasma ELA levels, routine blood test, blood lipid, liver and kidney functions were measured. The number of coronary arteries and SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score of coronary lesions were used to evaluate the extent of coronary artery stenosis.ResultsELA in patients with ACS was significantly higher than that in the control group (P < 0.01). There was no significant difference in plasma ELA levels among patients with single-, double- and triple-vessel diseases. However, in the generalized additive model (GAM), there was a threshold nonlinear correlation between the ELA levels and Syntax I score (P < 0.001). Plasma ELA levels were positively correlated with the Syntax I score when the ELA levels ranged from 63.47 to 85.49 ng/mL. There was no significant association between the plasma ELA levels and the extent of coronary artery stenosis when the ELA levels were less than 63.47 ng/mL or higher than 85.49 ng/mL.ConclusionThe present study demonstrates for the first time that plasma ELA levels are increased in patients with ACS. The rise in endogenous ELA levels was associated with severity of coronary stenosis and may be involved in the pathogenesis of ACS.     

急性冠脉综合征与血清尿酸的关系

目的:探讨急性冠脉综合征(ACS)与血清尿酸的关系。方法:应用酶联免疫吸附试验测定ACS组、稳定型心绞痛组、正常对照组血清尿酸水平,并进行统计学处理。结果:血清尿酸水平:ACS组的与稳定型心绞痛组、正常对照组的比较有显著性差异(P<0.05);稳定型心绞痛组的与正常对照组比较也有显著性差异(P<0.05)。结论: ACS发生与血清尿酸水平存在密切关系。     

急性冠状动脉综合征患者血清基质金属蛋白酶-9水平变化及意义

目的探讨急性冠状动脉综合征(ACS)患者血清基质金属蛋白酶-9(MMP-9)水平的变化及其临床意义。方法采用酶联免疫分析(ELISA)方法,测定ACS患者、稳定型心绞痛(SAP)患者和健康对照组血清MMP-9水平的变化。结果三组MMP-9分别为(284.30±64.60)ng/ml;(169.80±35.20)ng/ml;(164.40±33.80)ng/ml。三组间比较差异有显著性意义(P<0.001),三组间两两比较,ACS组与SAP组和对照组比较差异有显著性意义(P均<0.001),而SAP组和对照组比较差异无显著性意义(P=0.922)。按SAP、不稳定型心绞痛到急性心肌梗死由轻到重的等级排列,发现MMP-9由低到高的顺序排列,MMP-9水平与冠心病事件的严重程度呈正相关(r=0.762,P<0.001)。结论冠心病患者血清MMP-9水平增高可作为ACS的一个危险信号,同时也可以作为冠心病患者危险分层的一个重要生化监测指标。     

Anticoagulants in coronary artery disease

Anticoagulant therapy for acute coronary syndromes is becoming more complex as newer agents are added to unfractionated heparin and warfarin. The anticoagulants used in current clinical practice are low molecular weight heparins, direct thrombin inhibitors, and heparinoids. Properties of and recent clinical trial data regarding these newer anticoagulants are reviewed in reference to current American College of Cardiology/American Heart Association guidelines.     

Increased fibrinogen levels are associated with persistentChlamydia pneumoniaeinfection in unstable coronary artery disease

Aim Increased levels of acute phase proteins, e.g. fibrinogen, arerelated to a poor outcome in unstable coronary artery disease,but the cause of inflammation is unknown. We therefore investigatedthe prevalence of persistent Chlamydia pneumoniae infection,and its relationship to inflammation in this condition. Methods and Results In 256 patients participating in the FRISC trial, evaluatingthe effects of dalteparin (a low molecular weight heparin) inunstable angina or non-Q wave myocardial infarction, Chlamydiapneumoniae IgA antibody titres and levels of fibrinogen, C-reactiveprotein and troponin T were determined at inclusion. IncreasedC. pneumoniae IgA antibody titres were significantly more commonin the patients (36%) than in a reference popu-lation of similarage (19%); P<0·001. Raised titres were associatedwith male gender, increasing age, smoking, and elevated concentrationsof fibrinogen, C-reactive protein and troponin T. The associationbetween persistent C. pneumoniae infection and increased fibrinogenlevels was independent of other risk factors evaluated in multivariateanalysis (P=0·009). Conclusion Persistent C. pneumoniae infection is common in unstable coronaryartery disease. The independent association between increasedC. pneumoniae IgA antibody titres and fibrinogen levels indicatesthat chronic infection could be of importance for disease activity.     

胰岛素抵抗和纤溶功能紊乱与急性冠状动脉综合征的相关性研究

目的探讨胰岛素抵抗(IR)、纤溶功能紊乱与急性冠状动脉综合征(ACS)患者冠状动脉病变严重程度的关系及对患者近期预后的预测价值。方法连续收集2008年2月至2009年7月在我院心内科住院并诊断ACS的患者165例,按IR指数(HOMA指数)水平分为两组,IR组(HOMA-IR>5)80例,非IR组(HOMA-IR≤5)85例,分析两组患者间纤溶功能指标、冠状动脉病变严重程度的差异,并观察纤溶功能紊乱及IR对接受经皮冠状动脉介入治疗(PCI)的ACS患者近期(6个月内)预后的影响。结果与非IR组比较,IR组ACS患者组织纤溶酶原激活物(t-PA)水平较低[(8.56±2.39)μg/L比(11.06±2.12)μg/L,P<0.01],纤溶酶原激活物抑制物1(PAI-1)水平较高[(36.21±9.62)μg/L比(22.12±3.97)μg/L,P<0.01],并且冠状动脉病变的严重程度增加:多支病变[26例(32.5%)比13例(15.3%),P<0.05];B2/C型病变[29例(36.3%)比17例(20.0%),P<0.05];Gensini积分(55.63±14.24比44.11±11.42,P<0.01)。IR与PAI-1呈正相关(r=0.293,P<0.01);多因素Logistic回归分析显示,PAI-1及IR均是ACS患者近期预后的独立预测因子(P<0.05)。结论 ACS患者存在纤溶功能紊乱或IR时,冠状动脉病变更为严重,PAI-1水平及IR对ACS患者的近期预后有预测价值。     

Treatment strategies in the left main coronary artery disease associated with acute coronary syndromes

Significant left main coronary artery (LMCA) stenosis is not rare and reported 3 to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention is a still clinical challenge and surgery is still going to be a traditional management method in many cardiac centers. With a presentation of drug eluting stent (DES), extensive use of IVUS and skilled operators, number of such interventions increased rapidly which lead to change in recommendation in the guidelines regarding LMCA procedures in the stable angina (Class 2a recommendation for ostial and shaft lesion and class 2b recommendation for distal bifurcation lesion). However, there was not clear consensus about the management of unprotected LMCA lesion associated with acute myocardial infarction (MI) with a LMCA culprit lesion itself or distinct culprit lesion of other major coronary arteries. Surgery could be preferred as an obligatory management strategy even in the high risk patients. With this review, we aimed to demonstrate treatment strategies of LMCA disease associated with acute coronary syndrome, particularly acute myocardial infarction (MI). In addition, we presented a short case series with LMCA lesion and ST elevated acute MI in which culprit lesion placed either in the left anterior descending artery or circumflex artery. We reviewed the current medical literature and propose simple algorithm for management.Abbreviations: CABG, coronary artery bypass graft; CX, circumflex artery; DES, drug-eluting stent; IVUS, intravascular ultrasonography; LAD, left anterior descending artery; LMCA, left main coronary artery; MI, myocardial infarction; PCI, percutaneous coronary interventions; RCA, right coronary artery; SYNTAX, synergy between percutaneous coronary intervention with TAXUS and cardiac surgery; TIMI, thrombolysis in myocardial infarction