ADAMTS13水平与急性ST段抬高型心肌梗死心功能的关系研究  

Relationship between plasma von Willebrand factor lyase and cardiac function in patients with acute ST segment elevation myocardial infarction

作　　者：祖丽皮耶姆·希尔 彭辉[1] 排则莱提·艾海提 ZULIPIYEMU·Xier;PENG Hui;PAIZELAITI·Aihaiti(Department of Cardiology,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi,830001,China)

机构地区：[1]新疆维吾尔自治区人民医院心内科,乌鲁木齐830001

出　　处：《临床心血管病杂志》2020年第8期704-708,共5页Journal of Clinical Cardiology

基　　金：新疆维吾尔自治区自然科学基金项目(No:2017D01C131)。

摘　　要：目的:探讨急性ST段抬高型心肌梗死(STEMI)患者血浆血管性血友病因子裂解酶(ADAMTS13)水平与心功能的关系。方法:纳入2018年4月1日-2019年3月1日在新疆维吾尔自治区人民医院心内科住院并且行冠状动脉造影检查的急性STEMI患者143例(STEMI组),另纳入冠状动脉造影未见明显异常的患者143例(对照组)。采用双抗体夹心酶联免疫吸附法(ELISA)检测血浆ADAMTS13水平和血管性血友病因子(VWF)水平。根据Killip心功能分级,将STEMI组患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级4组,比较不同心功能分级组血浆ADAMTS13、VWF、高敏C反应蛋白(hs-CRP)、左室射血分数(LVEF)及血清脑钠肽(BNP)水平。通过二分类Logistic回归筛选STEMI的影响因素。结果:①STEMI组血浆ADAMTS13水平显著低于对照组[(1136.51±136.62)ng/m︰(2153.32±291.81)ng/ml,P<0.001]。②KillipⅢ级、Ⅳ级患者血浆ADAMTS13与VWF水平均显著高于KillipⅠ级、Ⅱ级患者(均P<0.05),而KillipⅠ级和Ⅱ级患者间比较差异无统计学意义。③二分类Logistic回归分析结果显示,控制混杂因素后,VWF(OR=1.006,P<0.05)、hs-CRP(OR=1.096,P<0.05)与BNP(OR=1.001,P<0.05)是STEMI的危险因素,而ADAMTS13(OR=0.49,P<0.05)与LVEF(OR=0.88,P<0.05)是保护因素。结论:STEMI患者血浆ADAMTS13水平明显升高,且急性期Killip心功能分级越高,ADAMTS13水平上升越明显。高水平的血浆ADAMTS13可能是STEMI患者心功能的保护因素。Objective:To investigate the relationship between plasma levels of von Willehemophilia factor lyase(ADAMTS13)and cardiac function in patients with acute ST segment elevation myocardial infarction(STEMI).Method:A total of 143 patients with acute STEMI hospitalized in the Department of Cardiology,People’s Hospital of Xinjiang Uygur Autonomous Region and underwent coronary angiography from April 1,2018 to March 1,2019 were included in the STEMI group,and other 143 patients without obvious abnormality indicated by coronary angiography were included into the control group.Plasma ADAMTS13 and von Willebrand factor(VWF)levels were measured by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).According to Killip cardiac function classification,patients with STEMI were divided into four groups:gradeⅠ,Ⅱ,Ⅲ,Ⅳ.The levels of plasma ADAMTS13,VWF,high sensitive C-reactive protein(hs-CRP),left ventricular ejection fraction(LVEF),and brain natriuretic peptide(BNP)were compared among groups with different Killip grades.The influencing factors of STEMI were screened by binary Logistic regression analysis.Result:①The level of plasma ADAMTS in the STEMI group was lower than that in the control group[(1136.51±136.62)ng/m vs(2153.32±291.81)ng/ml,P<0.001].②The levels of plasma ADAMTS13 and VWF in patients with Killip gradeⅢandⅣwere higher than those in gradeⅠandⅡ(all P<0.05),while the difference between in gradeⅠandⅡwas no significant.③Logistic regression analysis showed that VWF(OR=1.006,P<0.05),hs-CRP(OR=1.096,P<0.05)and BNP(OR=1.001,P<0.05)were risk factors of STEMI,while ADAMTS13(OR=0.49,P<0.05)and LVEF(OR=0.88,P<0.05)were protective factors.Conclusion:The level of ADAMTS13 is significantly increased in patients with STEMI,and the higher the Killip grade is,the more obvious the level of ADAMTS13 increase is.The high level of plasma ADAMTS13 may be a protective factor for cardiac function in STEMI patients.

关 键 词：急性ST段抬高型心肌梗死 血管性血友病因子裂解酶 血管性血友病因子 心功能 

分 类 号：R541.4[医药卫生—心血管疾病]