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不同阶段冠心病患者的脂联素——冠状动脉与外周静脉循环中脂联素浓度的比较

Adiponectin in patients with various stages of coronary heart disease - comparison of its concentration in coronary arteries and peripheral venous circulation.

作者信息

Stejskal David, Bartek Josef

机构信息

Department of Laboratory Medicine, Hospital Sternberk, Jívavská 20, 785 16 Sternberk, Czech Republic.

出版信息

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2003 Dec;147(2):161-6. doi: 10.5507/bp.2003.022.

Abstract

UNLABELLED

Adiponectin is an adipocytes-produced protein and showing a number of antiatherogenic effects. Adiponectin seems to be extensively deposited in the intersticium of venous lesions of persons with myocardial infarction. It may exhibit antiatherogenic and reparative effects. A decreased adiponectin concentration may be a risk factor of the origin and complications of atherosclerosis.

AIM OF THE STUDY

  1. Do the adiponectin concentrations in venous blood of persons with acute coronary syndrome (ACS) differ from those in persons with stress angina pectoris? 2) In these persons do adiponectin concentrations in venous blood differ from those in main coronary arteries? 3) Do adiponectin levels differ in the infarction and non-infarction arteries in persons with STEMI (ST Elevation Myocardial Infarct) and delay within 4 hours after the onset? 4) In persons with ACS does any correlation exist between venous adiponectin and common risk factors of cardiovascular complications? Adiponectin concentration was determined in samples of blood collected from the peripheral vein and during coronarography in various localizations in 4 groups of examined persons (I. - no signs of CAD, II. - stable stress angina pectoris, III. - ACS over 48 hours without elevations of ST segment, IV. - STEMI during first 4 hours after its origin and proved occlusion of coronary artery at coronarography). Coronary angiography, risk factors and anamnestic data were analyzed. The software Medcalc was used to perform statistical analysis. We examined 73 probands with signs of myocardial ischemia (mean age of 61.5 years, 64 % males), who were subjected to coronarography and 21 healthy volunteers. A mean delay (delay from the origin of complaints to the performed coronarography) was 3.1 +/- 0.5 hours in individuals in the group IV. In patients with ACS we found lower adiponectin concentrations in venous blood compared to healthy individuals and persons with stress AP, but changes were not statistically significant (I.: -5.9 +/- 2.7 ng/l, II.: -4.9 +/- 1.2 ng/l, III.: -5.2 +/- 4.1 ng/l, IV.: -4.6 +/- 2.7 ng/l); no differences were found also with BMI. No significant difference was recorded between the samples of venous blood and those of coronary arteries, nor between the infarction and the non-infarction arteries in the group IV. (5.2 +/- 2.6 ng/l vs. 4.8 +/- -2.7 ng/l). Significant negative correlations were observed between adiponectin concentrations and BMI (correlation coefficient -0.29), triacylglycerols (correlation coefficient -0.4), AOPP (correlation coefficient -0.39), and positive correlations with HDL (correlation coefficient 0.32). No correlation was recorded between adiponectin and CRP. Adiponectin concentrations in persons with ACS are lower than in healthy persons or patients with stable angina pectoris, but differences are not statistically significant. The absence of adiponectin differences between the infarction/non-infarction artery may support the hypothesis of adiponectin uptake in the ischemic lesion with subsequent decrease in blood adiponectin. On the contrary, adiponectin decrease may be a risk factor independent of the origin and development of ACS.
摘要

未标记

脂联素是一种由脂肪细胞产生的蛋白质,具有多种抗动脉粥样硬化作用。脂联素似乎广泛沉积在心肌梗死患者静脉病变的间质中。它可能具有抗动脉粥样硬化和修复作用。脂联素浓度降低可能是动脉粥样硬化发生及并发症的一个危险因素。

研究目的

1)急性冠状动脉综合征(ACS)患者静脉血中的脂联素浓度与应激性心绞痛患者的脂联素浓度是否不同?2)在这些患者中,静脉血中的脂联素浓度与主要冠状动脉中的脂联素浓度是否不同?3)ST段抬高型心肌梗死(STEMI)且发病后4小时内就诊的患者,梗死动脉和非梗死动脉中的脂联素水平是否不同?4)ACS患者静脉脂联素与心血管并发症的常见危险因素之间是否存在相关性?对4组受检者(I组 - 无CAD体征,II组 - 稳定型应激性心绞痛,III组 - 发病超过48小时且ST段无抬高的ACS,IV组 - STEMI发病后最初4小时内且冠状动脉造影证实冠状动脉闭塞)从外周静脉采集的血样以及冠状动脉造影不同部位采集的血样进行脂联素浓度测定。分析冠状动脉造影、危险因素和既往病史数据。使用Medcalc软件进行统计分析。我们检查了73例有心肌缺血体征的受试者(平均年龄61.5岁,64%为男性),这些受试者接受了冠状动脉造影检查以及21名健康志愿者。IV组个体的平均延迟时间(从出现症状到进行冠状动脉造影的延迟时间)为3.1±0.5小时。在ACS患者中,我们发现与健康个体和应激性心绞痛患者相比,静脉血中的脂联素浓度较低,但差异无统计学意义(I组:-5.9±2.7 ng/l,II组:-4.9±1.2 ng/l,III组:-5.2±4.1 ng/l,IV组:-4.6±2.7 ng/l);与BMI也无差异。静脉血样本与冠状动脉样本之间、IV组的梗死动脉和非梗死动脉之间均未记录到显著差异(5.2±2.6 ng/l对4.8± -2.7 ng/l)。观察到脂联素浓度与BMI(相关系数 -0.29)、三酰甘油(相关系数 -0.4)、晚期氧化蛋白产物(AOPP,相关系数 -0.39)之间存在显著负相关,与高密度脂蛋白(HDL,相关系数0.32)存在正相关。脂联素与CRP之间未记录到相关性。ACS患者的脂联素浓度低于健康人或稳定型心绞痛患者,但差异无统计学意义。梗死/非梗死动脉之间脂联素无差异可能支持脂联素在缺血病变中被摄取从而导致血液中脂联素随后降低这一假说。相反,脂联素降低可能是一个独立于ACS发生和发展的危险因素。

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