NLRP3炎性小体在急性非ST段抬高心肌梗死中的作用及其与血栓积分的关系  

The role of NLRP3 inflammasome in non-ST-segment elevation myocardial infarction and its relationship with thrombus score

作　　者：李继忠 李曼 魏鸾颍 Li Ji-zhong;Li Man;Wei Luan-ying(Emergency Department of Hebei PetroChina Central Hospital,Langfang 065000,China)

机构地区：[1]河北中石油中心医院急诊科,河北廊坊065000 [2]廊坊市人民医院药学部,河北廊坊065000

出　　处：《中国急救医学》2022年第5期436-440,共5页Chinese Journal of Critical Care Medicine

基　　金：廊坊市科技局市级自筹项目(2018013159)。

摘　　要：目的分析急性非ST段抬高心肌梗死(NSTEMI)患者的核苷酸结合寡聚化结构域样受体蛋白3(nucleotide-binding oligomerization domain-like receptor protein 3,NLRP3)炎性小体与血栓积分等指标的关系。方法选取河北中石油中心医院2021年1月至2021年5月收治的急性心肌梗死患者60例,按心电图ST段是否抬高分为非ST段抬高组(30例)和ST段抬高组(30例),并选择30例无心肌梗死的志愿者为健康对照组。三组均抽取静脉血20 mL进行血生化、肝肾、心肌等指标检测,计算血栓积分,并评价血栓负荷。同时采用Real-time PCR法与免疫印迹法分别进行外周血单核细胞NLRP3炎性小体mRNA水平和蛋白表达检测。比较非ST段抬高组患者各检测指标与其他两组的差异,并重点探讨NLRP3炎性小体与血栓积分的关系。非ST段抬高组根据血栓积分分为高血栓负荷组和低血栓负荷组,对各项指标进行比较。结果非ST段抬高组N末端B型脑利钠肽(NT-proBNP)、心肌肌钙蛋白I(cTnI)、血清高敏C-反应蛋白(hs-CRP)、血栓积分以及外周血单核细胞NLRP3 mRNA、NLRP3蛋白、白细胞介素(IL)-1β、IL-18均明显低于ST段抬高组(P<0.05)。动脉造影结果显示,非ST段抬高组三支病变发生率(46.67%vs.20.00%)、管腔狭窄程度>90%发生率(46.67%vs.20.00%)、侧支循环率(40.00%vs.13.33%)均较ST段抬高组更高(P<0.05)。高血栓负荷组NLRP3 mRNA(1.58±0.07 vs.1.32±0.11)、NLRP3蛋白(1.39±0.12 vs.1.14±0.09)、IL-18(pg/mL:28.19±4.33 vs.31.83±4.29)明显高于低血栓负荷组(P<0.05)。Pearson相关性分析显示,NLRP3炎性小体mRNA、NLRP3蛋白与血栓积分均呈明显正相关性(r=0.669、0.597,P均<0.05);NLRP3 mRNA与NLRP3蛋白预测血栓负荷的ROC曲线下面积(AUC)分别为0.78、0.72。结论急性NSTEMI患者的NLRP3炎性小体表达与血栓积分存在相关性,对判断患者病情变化有一定的指导意义。Objective To analyze the relationship between nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)inflammatory body and thrombus score in the patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods 60 patients with myocardial infarction treated in the emergency department of Langfang People′s Hospital from January 2021 to May 2021 were divided into non-ST-segment elevation group(30 cases)and ST-segment elevation group(30 cases)according to whether the ST segment of ECG was elevated or not,and 30 volunteers without myocardial infarction were selected as the healthy group.20 mL venous blood was drawn from the three groups for blood biochemistry,liver,kidney,myocardium and other indexes,and thrombus score was calculated.At the same time,the mRNA level and protein expression of NLRP3 inflammatory bodies in peripheral blood monocytes were detected by real-time PCR and Western blotting.To compare the differences of detection indexes between non-ST-segment elevation group and the other two groups,and to focus on the relationship between NLRP3 inflammatory body and thrombus score.Results N-terminal B-type natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),serum high-sensitivity C-reactive protein(hs-CRP),thrombus score,and peripheral blood mononuclear cell NLRP3 mRNA,NLRP3 protein expression level,interleukin-1β,and interleukin-18 expression were significantly lower in the non-ST-segment elevation group than in the ST-segment elevation group(P<0.05).In the analysis of arteriography results,the non-ST-segment elevation group had a higher incidence of three-branch lesions(46.67%vs.20.00%),luminal stenosis>90%(46.67%vs.20.00%),and collateral circulation rate(40.00%vs.13.33%)compared with the ST-segment elevation group(P<0.05).NLRP3 mRNA(1.58±0.07 vs.1.32±0.11),NLRP3 protein(1.39±0.12 vs.1.14±0.09),and interleukin-18 expression(pg/mL:28.19±4.33 vs.31.83±4.29)were higher in the high thrombus load group compared to the low thrombus load group(P<0.05).Pearson correlation an

关 键 词：非ST段抬高型心肌梗死(NSTEMI) 核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体 血栓积分 相关性 

分 类 号：R542.22[医药卫生—心血管疾病]