低密度脂蛋白受体相关蛋白5对糖尿病合并心肌梗死患者心肌纤维化的影响  

Relationship between serum low-density lipoprotein receptor-related protein 5 and myocardial fibrosis in diabetic patients with myocardial infarction

作　　者：张辉 付东琳 柏明成 Zhang Hui;Fu Donglin;Bai Mingcheng(Department of Cardiovascular Medicine,Yanting County People's Hospital,Mianyang 621699;Department of Critical Care Medicine,Chongqing People's Hospital,Chongqing 401121,China)

机构地区：[1]四川省盐亭县人民医院心血管内科,绵阳621699 [2]重庆市人民医院重症医学科,401121

出　　处：《国际心血管病杂志》2024年第4期242-246,共5页International Journal of Cardiovascular Disease

摘　　要：目的:探讨血清低密度脂蛋白受体相关蛋白5(LRP5)对2型糖尿病(T2DM)合并急性心肌梗死(AMI)患者心肌纤维化(MF)的影响。方法:选取四川省盐亭县人民医院2021年3月至2023年11月收治的142例AMI患者,其中45例合并T2DM的患者为T2DM+AMI组,97例未合并T2DM的患者为AMI组。比较2组一般资料、LRP5表达水平、心功能指标和MF指标;采用Pearson相关分析T2DM+AMI组患者LRP5表达水平与心功能和MF指标的相关性;采用单因素有序logistic回归分析T2DM+AMI组患者LRP5表达水平对MF指标的影响。结果:T2DM+AMI组多支血管病变比例、Killip分级Ⅲ~Ⅳ级患者比例高于AMI组(P<0.05);T2DM+AMI组左室射血分数(LVEF)、每搏输出量(SV)、心输出量(CO),二尖瓣口舒张早期和晚期血流速度峰值的比值(E/A)低于AMI组(P<0.05);T2DM+AMI组透明质酸(HA)、Ⅰ型前胶原(PCⅠ)、Ⅲ型前胶原(PCⅢ)、转化生长因子-β1(TGF-β1)、基质金属蛋白酶-2(MMP-2)表达水平高于AMI组(P<0.05);相关分析显示,T2DM+AMI患者LRP5表达水平与LVEF、SV、CO、E/A呈负相关(r=-0.275、-0.211、-0.242、-0.234,P均<0.05),与HA、PCⅠ、PCⅢ、TGF-β1、MMP-2呈正相关(r=0.316、0.332、0.354、0.395、0.366,P均<0.05);单因素有序logistic回归分析结果显示LRP5是T2DM+AMI患者HA(OR=1.291)、PCⅠ(OR=1.273)、PCⅢ(OR=1.682)、TGF-β1(OR=1.935)、MMP-2(OR=1.643)表达水平增加的危险因素(P<0.05)。结论:T2DM合并AMI患者心功能恶化与MF程度比单纯AMI患者更加严重,LRP5表达水平增加是T2DM合并AMI患者发生MF的危险因素。Objective:To investigate the effect of serum low-density lipoprotein receptor-related protein 5(LRP5)in the pathogenesis of myocardial fibrosis(MF)in patients with type 2 diabetes mellitus(T2DM)complicated with acute myocardial infarction(AMI).Methods:142 patients with AMI admitted to Yanting County People's Hospital in Sichuan Province from March 2021 to November 2023 were enrolled.Among them,45 patients had T2DM and 97 were non-diabetics.Clinical characteristics,serum level of LRP5 expression,cardiac function and degree of MF were compared between the two groups.Pearson correlation was used to analyze the relationship between LRP5 expression level and cardiac function and MF,and univariate logistic regression was performed to determine the effect of LRP5 expression on degree of MF in patients with T2DM and AMI.Results:The proportions of multi-vessel disease and Killip classⅢorⅣwere higher,left ventricular ejection fraction(LVEF),stroke volume,cardiac output and E/A ratio were lower,and hyaluronic acid(HA),pro-collagenⅠorⅢ,TGF-β1 and MMP-2 were more elevated in diabetic patients with AMI compared to those in non-diabetic AMI patients(all P<0.05).Serum level of LRP5 expression correlated inversely with LVEF,stroke volume,cardiac output and E/A(r=-0.275,-0.211,-0.242,-0.234,all P<0.05),but was positively related to HA,pro-collagenⅠorⅢ,TGF-β1 and MMP-2 in T2DM patients with AMI(r=0.316,0.332,0.354,0.395,0.366,all P<0.05).Univariate logistic regression analysis showed that LRP5 was associated with increased HA(OR=1.291),pro-collagenⅠ(OR=1.273)orⅢ(OR=1.682),TGF-β1(OR=1.935)and MMP-2(OR=1.643)in diabetic AMI patients(P<0.05).Conclusion:T2DM patients with AMI had lower cardiac function and higher degree of MF compared with non-diabetic AMI patients.An increased expression of LRP5 confers a risk factor for MF in patients with T2DM and AMI.

关 键 词：低密度脂蛋白受体相关蛋白5 心肌纤维化 糖尿病 心肌梗死 心力衰竭 

分 类 号：R587.2[医药卫生—内分泌] R542.22[医药卫生—内科学]