血浆Big ET-1、SIRT1、CXCL12在ACS合并T2DM患者中的变化及与冠脉病变的相关性  

Changes of plasma Big ET-1,SIRT1 and CXCL12 in the patients with ACS and T2DM and their correlation with coronary artery disease

作　　者：郝佳 王慧峰[1] 张强 刘飞君[1] 马慧荣 Hao Jia;Wang Huifeng;Zhang Qiang;Liu Feijun;Ma Huirong(General Hospital of Taiyuan Iron and Steel(Group)Company Limited&Department of Cardiology,the Sixth Hospital of Shanxi Medical University,Taiyuan 030003,China)

机构地区：[1]太原钢铁(集团)有限公司总医院/山西医科大学第六医院心内科,山西太原030003

出　　处：《中国急救医学》2025年第2期111-116,共6页Chinese Journal of Critical Care Medicine

基　　金：山西省卫生健康委科研课题计划(2019112)。

摘　　要：目的探究血浆大内皮素(Big ET-1)、沉默信息调节因子1(Sirtuin-1,SIRT1)和CXC趋化因子配体12(CXCL12)在急性冠状动脉综合征(ACS)合并2型糖尿病(T2DM)患者中的变化及与冠脉病变的相关性。方法选取2021年3月至2023年3月太原钢铁(集团)有限公司总医院100例ACS合并T2DM患者作为研究组,另选同期100例ACS非糖尿病患者作为对照组。比较两组血浆Big ET-1、SIRT1和CXCL12水平,比较研究组不同冠脉病变程度患者临床资料及血浆Big ET-1、SIRT1和CXCL12水平,分析ACS合并T2DM患者冠脉病变程度加重的影响因素,分析血浆Big ET-1、SIRT1和CXCL12水平评估ACS合并T2DM患者冠脉病变程度加重的价值,比较方案A[冠心病家族史、血清同型半胱氨酸(Hcy)和前蛋白转化酶枯草溶菌素9(PCSK9)、左室射血分数(LVEF)及血浆Big ET-1、SIRT1和CXCL12水平联合评估]与方案B(冠心病家族史、血清Hcy、PCSK9和LVEF联合评估)的评估效果。结果研究组血浆Big ET-1、SIRT1和CXCL12水平高于对照组(P<0.05);冠脉病变重度患者有冠心病家族史占比、血清Hcy、PCSK9水平及血浆Big ET-1、SIRT1和CXCL12水平高于轻度患者,LVEF低于轻度患者(P<0.05);冠心病家族史、血清Hcy和PCSK9水平及血浆Big ET-1、SIRT1和CXCL12水平均为ACS合并T2DM患者冠脉病变程度加重的独立危险因素,LVEF是保护因素(P<0.05);血浆Big ET-1、SIRT1和CXCL12评估ACS合并T2DM患者冠脉病变程度加重的AUC分别为0.741、0.751和0.789;方案A评估的ACU为0.942(95%CI 0.876~0.979),大于方案B评估的ACU 0.859(95%CI 0.775~0.921)(P<0.05)。结论血浆Big ET-1、SIRT1和CXCL12升高与ACS合并T2DM具有紧密联系,为临床早期评估冠脉病变程度提供参考。Objective To explore the changes of plasma big endothelin-1(Big ET-1),silent information regulator 1(Sirtuin-1,SIRT1)and CXC chemokine ligand 12(CXCL12)in the patients with acute coronary syndrome(ACS)complicated with type 2 diabetes mellitus(T2DM)and their correlation with coronary artery disease.Methods A total of 100 patients with ACS complicated with T2DM in General Hospital of Taiyuan Iron and Steel(Group)Company Limited from March 2021 to March 2023 were selected as the study group,and 100 non-diabetic patients with ACS were selected as the control group during the same period.Plasma levels of Big ET-1,SIRT1 and CXCL12 were compared between the two groups,as well as clinical data,plasma levels of Big ET-1,SIRT1 and CXCL12 of patients with different degrees of coronary artery disease in the study group,and the influencing factors of the severity of coronary artery disease in ACS patients complicated with T2DM were analyzed.The value of plasma levels of Big ET-1,SIRT1 and CXCL12 in evaluating the severity of coronary lesions in ACS patients complicated with T2DM was analyzed,and plan A[family history of coronary heart disease,serum homocysteine(Hcy),proprotein convertase subtilisin/kexin type9(PCSK9)levels,left ventricular ejection fraction(LVEF),plasma Big ET-1,SIRT1 and CXCL12 joint evaluation]and plan B(family history of coronary heart disease,serum Hcy,PCSK9 and LVEF joint evaluation)were compared.Results Plasma levels of Big ET-1,SIRT1 and CXCL12 in study group were higher than those in control group(P<0.05).The family history of coronary heart disease,plasma Big ET-1,SIRT1 and CXCL12 levels in severe patients were higher than those in mild patients,and LVEF was lower than those in mild patients(P<0.05).Family history of coronary heart disease,serum Hcy,PCSK9 levels,plasma Big ET-1,SIRT1 and CXCL12 levels were independent risk factors for the severity of coronary artery disease in ACS patients complicated with T2DM,and LVEF was a protective factor(P<0.05).The area under curve(AUC)of plasma Big ET-1,SIRT1

关 键 词：急性冠状动脉综合征 2型糖尿病 大内皮素 沉默信息调节因子1 CXC趋化因子配体12 冠脉病变程度 

分 类 号：R587.2[医药卫生—内分泌] R541.4[医药卫生—内科学]