血清内源性Apela在冠状动脉粥样硬化心力衰竭患者中的水平变化及临床特点  

The clinical characteristics and changes of serum apela in heart failure patients with coronary atherosclerotic disease

作　　者：李静[1] 王治 金亮丽 潘扬 张文 丁畅 黄进 LI Jing;WANG Zhi;JIN Liang-li;PAN Yang;ZHANG Wen;DING Chang;HUANG Jin(Department of Cardiology,Nanjing Brain Hospital(Nanjing Chest Hospital),Nanjing 210029,China;Internal Medicine,Taishan Street Community Health Service Center,Jiangbei new district,Nanjing 210031,China)

机构地区：[1]南京脑科医院(南京市胸科医院)心内科,江苏省南京市210029 [2]南京市江北新区泰山街道社区卫生服务中心内科

出　　处：《中国心血管病研究》2021年第4期289-293,共5页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81570365);南京市医疗卫生科技项目(201803022);南京市科技发展项目(ZKX17046)。

摘　　要：目的探讨冠状动脉粥样硬化心力衰竭患者血清Apela水平变化。方法入选2019年1月至12月在南京市胸科医院心内科住院的心力衰竭患者64例,根据冠状动脉造影结果分为冠状动脉粥样硬化CAD)心力衰竭组33例,和非冠状动脉粥样硬化(non-CAD)心力衰竭组31例;CAD组进一步分为单支病变组14例,多支病变组19例。应用全自动生化仪检测患者肝肾功能;电化学发光免疫法检测氨基末端脑钠肽前体蛋白(NT-proBNP),酶联免疫吸附法(ELISA)检测Apela水平,Teich法测定左室射血分数(LVEF)。对人脐静脉内皮细胞(HUVEC)用不同浓度Apela干预进行成管实验。结果CAD心力衰竭组患者血清内源性Apela水平较non-CAD心力衰竭组显著降低(2.21 ng/ml比3.22 ng/ml,P<0.01),其中多支病变CAD心力衰竭组患者血清NT-proBNP显著高于单支病变CAD心力衰竭组(5000 ng/L比1680 ng/L,P<0.05),而血清Apela水平(1.80 ng/ml比2.71 ng/ml,P<0.01)及LVEF[(46.8±1.9)%vs.(55.1±2.2)%,P<0.01]显著低于单支病变CAD心力衰竭组。多因素logistic回归分析显示Apela水平与CAD心力衰竭患者冠状动脉病变支数独立相关(OR=0281,95%CI 0.106~0.748)。体外成管实验显示Apela呈浓度依赖性促进HUVEC形成管状结构。结论冠状动脉粥样硬化心力衰竭患者血清内源性Apela浓度与冠状动脉病变程度相关。Objective To investigate the change of serum apela level in heart failure patients with coronary atherosclerotic disease(CAD).Methods 64 patients with heart failure hospitalized in the Department of Cardiology in Nanjing Chest Hospital from January to December 2019 were selected and divided into CAD group(33 cases)and non-CAD group(31 cases)according to the results of coronary angiography.The CAD patients were further divided into single-vessel(14 cases)and multi-vessel(19 cases)disease subgroups.The liver and kidney functions were detected by automatic biochemical analyzer;N-terminal pro-brain natriuretic peptide(NTpro BNP)levels were detected by electrochemiluminescence immunoassay;circulating apela level was detected by enzyme-linked immunosorbent assay(ELISA);and left ventricular ejection fraction(LVEF)was measured by Teich method.Tube formation was tested in Human umbilical vein endothelial cells(HUVEC)treated with different concentrations of apela.Results The level of apela in CAD group was significantly lower than that in non-CAD group(2.21 ng/ml vs.3.22 ng/ml,P<0.01).The level of apela(1.80 ng/ml vs.2.71 ng/ml,P<0.01)and the mean value of LVEF[(46.8±1.9)%vs.(55.1±2.2)%,P<0.01]were significantly lower in multi-vessel subgroup than that in single-vessel subgroup,while the NT-pro BNP level was higher in multi-vessel subgroup(5000 ng/L vs.1680 ng/L,P<0.05).Logistic regression analysis showed that apela level was independently correlated with the number of coronary artery lesions in heart failure patients with CAD(OR=0281,95%CI 0.106~0.748).Apela enhanced the tube formation of HUVEC in a dose-dependent manner.Conclusion The level of serum endogenous apela is correlated with the severity of coronary artery disease in heart failure patients with CAD.

关 键 词：Apela 冠状动脉粥样硬化 心力衰竭 生物学标志物 

分 类 号：R541.6[医药卫生—心血管疾病]