Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Peoples' Republic of China.
Int J Cardiol. 2013 Sep 10;167(6):2813-9. doi: 10.1016/j.ijcard.2012.07.007. Epub 2012 Aug 24.
Recent experimental evidence suggests that the Rho/Rho-kinase (ROCK) system may play an important role in the pathogenesis of acute coronary syndrome (ACS) but there are little clinical data. This study examined if ROCK activity is increased in patients with acute coronary syndrome and if ROCK activity predicts long-term cardiovascular event.
Blood samples were collected from 188 patients within 12h after admission for ACS (53% men; aged 70 ± 13) and from 61 control subject. The main outcome measures were all cause mortality, readmission with ACS or congestive heart failure (CHF) from presentation within around 2 years (mean:14.4 ± 7.2 months; range: 0.5 to 26 months).
ROCK activity increased in ST elevation myocardial infarction (STEMI, n=90) (3.33 ± 0.93), non-STEMI (NSTEMI, n=68) (3.37 ± 1.04) and unstable angina (UA, n=30) (2.53 ± 0.59) groups when compared with disease controls (n=31) (2.06 ± 0.38, all p<0.001) and healthy controls (n=30) (1.54 ± 0.43, all p<0.001). There were 24 deaths, 34 readmissions with ACS and 15 admissions with CHF within 2 years. Patients with a high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high ROCK activity on admission had a five-fold risk of a cardiovascular event (RR: 5.156; 95% CI: 2.180-12.191) when compared to those with low NT-proBNP and low ROCK activity.
ROCK activity was increased in patients with ACS, particularly in those with myocardial infarction. The combined usage of both ROCK activity and NT-proBNP might identify a subset of ACS patients at particularly high risk.
最近的实验证据表明，Rho/Rho-激酶（ROCK）系统可能在急性冠状动脉综合征（ACS）的发病机制中起重要作用，但临床数据很少。本研究检测了 ROCK 活性是否在急性冠状动脉综合征患者中升高，以及 ROCK 活性是否预测长期心血管事件。
在 ACS 发病后 12 小时内，从 188 名患者（53%为男性；年龄 70 ± 13 岁）和 61 名对照者中采集血样。主要观察终点为全因死亡率、ACS 再入院或充血性心力衰竭（CHF）的入院率，随访时间约为 2 年（平均：14.4 ± 7.2 个月；范围：0.5 至 26 个月）。
与疾病对照组（n=31）（2.06 ± 0.38，均 p<0.001）和健康对照组（n=30）（1.54 ± 0.43，均 p<0.001）相比，ST 段抬高型心肌梗死（STEMI，n=90）（3.33 ± 0.93）、非 ST 段抬高型心肌梗死（NSTEMI，n=68）（3.37 ± 1.04）和不稳定型心绞痛（UA，n=30）（2.53 ± 0.59）患者的 ROCK 活性均升高。随访 2 年内有 24 例死亡，34 例 ACS 再入院，15 例 CHF 入院。入院时 N 端脑利钠肽前体（NT-proBNP）高和 ROCK 活性高的患者发生心血管事件的风险是 NT-proBNP 和 ROCK 活性低的患者的五倍（RR：5.156；95%CI：2.180-12.191）。
ACS 患者的 ROCK 活性升高，尤其是心肌梗死患者。ROCK 活性和 NT-proBNP 的联合使用可能会识别出 ACS 患者中风险特别高的亚组。
