【摘要】：目的:探討血清乳脂球表皮生長(zhǎng)因子-8(Milk fat globule epidermal growth factor-8,MFG-E8)在急性心肌梗死(Acute myocardial infarction,AMI)患者心肌缺血再灌注損傷(Myocardial ischemia reperfusion injury,MIRI)過程中的表達(dá),以及(MFG-E8與超敏C反應(yīng)蛋白(high-sensitivity C-reactive protein,Hs-CRP)、白介素-6(Interleukin-6,IL-6)相關(guān)性的研究。方法:選擇2014年1月至2014年8月因急性心肌梗死于濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院就診,且發(fā)病6小時(shí)之內(nèi),經(jīng)綠色通道行PCI治療的ST段抬高型心肌梗死(ST elevated myocardial infarction,STEMI)患者40例作為AMI組,另選擇同期因胸部不適于我院心內(nèi)科住院治療,并行冠脈造影檢查,結(jié)果示冠脈未見明顯狹窄病變的患者30例作為對(duì)照組。兩組患者均于PCI或冠狀動(dòng)脈造影(Coronary angiography,CAG)術(shù)前、術(shù)后24小時(shí)、術(shù)后48小時(shí)抽取靜脈血5ml,離心后保存于-80°C冰箱中。所有患者均于入院當(dāng)日行肌鈣蛋白、肌酸激酶同工酶、BNP、肝功能、腎功能、血脂、血糖監(jiān)測(cè),同時(shí)記錄心肌梗死相關(guān)血管開通后出現(xiàn)的心律失常類型,進(jìn)一步追蹤住院期間發(fā)生不良事件的情況(如再發(fā)心肌梗死、心力衰竭、心源性休克、心源性猝死、嚴(yán)重心律失常等)。標(biāo)本收集完畢后,用ELISA法檢測(cè)血清MFG-E8、Hs-CRP、IL-6水平,比較不同時(shí)間點(diǎn)上各因子水平變化。用SPSS18.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:(1)AMI組各時(shí)間點(diǎn)血清MFG-E8水平均低于相應(yīng)時(shí)間點(diǎn)對(duì)照組,組間差異有統(tǒng)計(jì)學(xué)意義(P=0.003、P=0.006、P=0.002)。AMI組血清MFG-E8水平術(shù)后24小時(shí)較術(shù)前出現(xiàn)明顯升高(P=0.006),且術(shù)后48小時(shí)血清mfg-e8水平繼續(xù)升高,與術(shù)前、術(shù)后24小時(shí)組間差異有統(tǒng)計(jì)學(xué)意義(p=0.005、p=0.001)。對(duì)照組術(shù)前、術(shù)后24小時(shí)、術(shù)后48小時(shí)血清mfg-e8水平組間比較差異無統(tǒng)計(jì)學(xué)意義(p=0.067、p=0.059、p=0.150)。(2)ami組各時(shí)間點(diǎn)血清hs-crp水平均高于相應(yīng)時(shí)間點(diǎn)對(duì)照組,組間差異有統(tǒng)計(jì)學(xué)意義(p=0.012、p=0.006、p=0.005)。ami組血清hs-crp水平術(shù)后24小時(shí)較術(shù)前出現(xiàn)明顯升高(p=0.002);術(shù)后48小時(shí)血清hs-crp水平較術(shù)后24小時(shí)明顯下降(p=0.008),但較術(shù)前仍明顯升高(p=0.005)。對(duì)照組術(shù)前、術(shù)后24小時(shí)、術(shù)后48小時(shí)血清hs-crp水平組間比較差異無統(tǒng)計(jì)學(xué)意義(p=0.100、p=0.350、p=0.058)。(3)ami組各時(shí)間點(diǎn)血清il-6水平均高于相應(yīng)時(shí)間點(diǎn)對(duì)照組,組間差異有統(tǒng)計(jì)學(xué)意義(p=0.009、p=0.003、p=0.028)。ami組血清il-6水平術(shù)后24小時(shí)較術(shù)前出現(xiàn)明顯升高(p=0.002);術(shù)后48小時(shí)血清il-6水平繼續(xù)升高,與術(shù)前、術(shù)后24小時(shí)組間差異有統(tǒng)計(jì)學(xué)意義(p=0.003、p=0.001)。對(duì)照組術(shù)前、術(shù)后24小時(shí)、術(shù)后48小時(shí)血清il-6水平組間比較差異無統(tǒng)計(jì)學(xué)意義(p=0.055、p=0.140、p=0.320)。(4)ami組各時(shí)間點(diǎn)血清mfg-e8水平與hs-crp水平呈負(fù)相關(guān)(r=-0.774,p=0.003;r=-0.462,p=0.006;r=-0.744,p=0.008),與il-6水平呈負(fù)相關(guān)(r=-0.514,p=0.006;r=-0.408,p=0.005;r=-0.439,p=0.004);ami組各時(shí)間點(diǎn)血清hs-crp水平與il-6水平呈正相關(guān)(r=0.434,p=0.003;r=0.436,p=0.008;r=0.399,p=0.001)。(5)ami組中心肌梗死相關(guān)血管(ira)開通即刻均觀察到再灌注心律失常的發(fā)生(ra),包括:竇性心動(dòng)過緩、室性早搏、房性早搏、室顫、房室傳導(dǎo)阻滯、竇性停搏、室性心動(dòng)過速。(6)根據(jù)術(shù)后24小時(shí)的bnp是否正常,將ami組患者分為bnp異常組和bnp正常組,其中bnp異常組患者較正常者各時(shí)間點(diǎn)mfg-e8水平均明顯降低(p=0.003)。(7)根據(jù)住院期間是否發(fā)生不良事件,將AMI組患者分為發(fā)生不良事件組及未發(fā)生不良事件組,發(fā)生院內(nèi)不良事件患者較未發(fā)生不良事件患者各時(shí)間點(diǎn)MFG-E8水平明顯降低(P=0.012)。結(jié)論:(1)MFG-E8參與了AMI患者PCI手術(shù)治療中MIRI的過程,在此過程中可能是通過抑制炎性細(xì)胞因子Hs-CRP、IL-6釋放,而參與MIRI過程。(2)MFG-E8對(duì)于急性心肌梗死患者遠(yuǎn)期預(yù)后有一定的預(yù)測(cè)價(jià)值。
[Abstract]:Objective: To investigate the expression of serum milk fat ball epidermal growth factor-8 (MFG-MAA) in acute myocardial infarction (AMI) patients with myocardial ischemia-reperfusion injury (MIRI) and (MFG-VEP) and hypersensitive C-reactive protein (Hs-CRP). Study on the correlation between interleukin-6 (interleukin-6, IL-6). Methods: 40 patients with ST-segment elevation myocardial infarction (STEMI) treated with PCI were treated as AMI group from January 2014 to August 2014 due to acute myocardial infarction. During the same period, the chest was not suitable for hospitalization in our hospital, and coronary angiography was performed in parallel. The results showed that 30 patients with no obvious stenosis were treated as control group. Two groups of patients were treated with PCI or coronary angiography (CAG), 24 hours after operation, 5 ml of venous blood were taken after 48 hours of operation, and then stored in -80 擄 C refrigerator after centrifugation. All patients had cardiac troponin, creatine kinase isoenzymes, BNP, liver function, renal function, blood lipid and blood glucose monitoring on the day of admission, and also recorded the type of arrhythmia that occurred after myocardial infarction related blood vessels were opened. Further tracking of adverse events during hospitalization (e.g., recurrent myocardial infarction, heart failure, cardiogenic shock, sudden cardiac death, severe arrhythmia, etc.). After the samples were collected, the levels of MFG-, Hs-CRP and IL-6 were detected by ELISA, and the levels of various factors were compared at different time points. Statistical analysis was performed with SPSS18. 0 software. Results: (1) The levels of MFG and MFG in each time point of AMI group were lower than those of control group at corresponding time point (P = 0.0003, P = 0.0006, P = 0.0002). The level of mfg-e8 in serum of AMI group increased significantly at 24 hours after operation (P = 0.0006), and the level of mfg-e8 in serum of AMI group continued to increase within 48 hours after operation (p = 0.0005, p = 0.0001). There was no significant difference in serum mfg-e8 levels after operation (p = 0.067, p = 0.059, p = 0.150). (2) The levels of hs-crp in each time point of ami group were higher than those of control group at corresponding time point (p = 0.0012, p = 0.0006, p = 0.0005). The serum hs-crp levels in the ami group increased significantly at 24 hours after operation (p = 0.0002), and the serum hs-crp level decreased significantly at 48 hours after operation (p = 0.0008), but still increased significantly before operation (p = 0.0005). There was no significant difference (p = 0.100, p = 0.350, p = 0.058) between the levels of hs-crp in serum before and after operation. (3) The level of serum IL-6 in each time point of the ami group was higher than that of the control group at the corresponding time point (p = 0.0009, p = 0.0003, p = 0.028). The serum IL-6 level in the ami group increased significantly before operation (p = 0.0002), and the serum IL-6 level continued to increase within 48 hours after operation (p = 0.0003, p = 0.0001). There was no significant difference in serum IL-6 group after operation (p = 0.055, p = 0.140, p = 0.320). (4) The level of mfg-e8 in each time point of the ami group was negatively correlated with the hs-crp level (r =-0.474, p = 0.003; r =-0.462, p = 0.00006; r =-0.474, p = 0.00008), negatively correlated with the level of il-6 (r =-0.408, p = 0.00005; r =-0.439, p = 0.00004); the level of hs-crp in each time point of the ami group was positively correlated with the il-6 level (r = 0.434, p = 0.00003; r = 0.436, p = 0.0008; r = 0.9399, p=0.001). (5) The occurrence (ra) of reperfusion arrhythmia was observed immediately after the opening of the infarct-related blood vessel (ira) in the ami group, including: slow onset, premature ventricular premature beat, atrial premature beat, ventricular fibrillation, atrioventricular block, atrial arrest, ventricular tachycardia. (6) According to whether bnp was normal at 24 hours after operation, the patients were divided into the bnp abnormal group and the bnp normal group, among which, the mfg-e8 levels in the bnp abnormal group were significantly lower than those in each time point mfg-e8 (p = 0. 003). (7) According to the occurrence of adverse events during hospitalization, the patients of AMI group were divided into adverse event group and no adverse event group, and the MFG-VEP level was significantly lower in patients with adverse events in hospital than those in the absence of adverse events (P = 0.0012). Conclusion: (1) MFG-NHL is involved in the process of MIRI in patients with AMI, and may be involved in MIRI process by inhibiting inflammatory cytokines Hs-CRP and IL-6 release. (2) MFG-MAA has a certain predictive value for the long-term prognosis of patients with acute myocardial infarction.
【學(xué)位授予單位】：濟(jì)寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R542.22

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