吳韞韜,洪春榮
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·臨床醫(yī)學(xué)·
·論著·
半乳凝素-3在不穩(wěn)定型心絞痛患者中的檢測(cè)價(jià)值
吳韞韜,洪春榮
目的探討在診斷不穩(wěn)定型心絞痛(UA)中半乳凝素-3(galectin-3)的臨床檢測(cè)價(jià)值。方法分析2014年10月至2015年10月在我院接受治療的48例UA患者和38例穩(wěn)定型心絞痛(SA)患者的臨床資料,另外選取同期接受體檢的38例健康體檢者作為本次研究的對(duì)照組。比較3組患者的基線資料、galectin-3和超敏C反應(yīng)蛋白(hs-CRP)的表達(dá)水平,通過ROC曲線分析galectin-3對(duì)UA的診斷價(jià)值。結(jié)果3組患者在年齡、性別等基線資料比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05);UA組患者的galectin-3、hs-CRP水平明顯高于SA組,差異有統(tǒng)計(jì)學(xué)意義(P<0.01);UA組和SA組患者的galectin-3、hs-CRP水平均明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。用ROC曲線分析galectin-3對(duì)UA患者的診斷價(jià)值發(fā)現(xiàn)曲線下面積是0.902。結(jié)論galectin-3和hs-CRP均可以間接體現(xiàn)斑塊的穩(wěn)定性,且galectin-3對(duì)UA的診斷更為準(zhǔn)確。
不穩(wěn)定型心絞痛;半乳凝素-3;穩(wěn)定型心絞痛;超敏C反應(yīng)蛋白
隨著人們生活水平的提高,冠心病(CHD)迅速成為對(duì)人類生命構(gòu)成最嚴(yán)重威脅的一類疾病,其中不穩(wěn)定型心絞痛(UA)是主要類型之一,具有致死率高及病情進(jìn)展快等特點(diǎn)[1]。半乳凝素-3(galectin-3)有著獨(dú)特的嵌合結(jié)構(gòu),是半乳凝素家族的一個(gè)重要成員,是內(nèi)皮細(xì)胞、巨噬細(xì)胞以及平滑肌細(xì)胞源性的一個(gè)多功能蛋白,起著放大炎癥信號(hào)的作用[2]。筆者通過對(duì)UA患者中g(shù)alectin-3水平的檢測(cè),探析galectin-3在臨床檢測(cè)中價(jià)值?,F(xiàn)報(bào)道如下。
1.1研究對(duì)象分析2014年12月至2015年12月在我院接受治療的48例UA患者(UA組)和38例穩(wěn)定型心絞痛(SA)患者(SA組)的臨床資料,另外選取同期接受體檢的38例健康體檢者作為本次研究的對(duì)照組。入選者的診斷均需符合美國(guó)心臟病學(xué)會(huì)(ACC)/美國(guó)心臟學(xué)會(huì)(AHA)于2005年制定的關(guān)于CHD的診斷標(biāo)準(zhǔn)[3]。入選者入院均需接受常規(guī)的超聲心動(dòng)圖、心電圖以及肝腎功能等的檢測(cè)。排除標(biāo)準(zhǔn):肝腎功能不全者;心肌病患者;合并感染的患者;近期服用藥物的患者;由于自身免疫性疾病等導(dǎo)致galectin-3水平明顯上升的患者。3組患者在年齡、性別等基線資料間的比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。見表1。
表1 3組患者基線資料的比較
注:UA為不穩(wěn)定型心絞痛,SA為穩(wěn)定型心絞痛
1.2研究方法主要儀器和試劑:全自動(dòng)生化分析儀器(南京基蛋生物科技有限公司)。超敏C反應(yīng)蛋白(hs-CRP)測(cè)定試劑盒(Bender Medsystems公司,奧地利),galectin-3測(cè)定試劑盒(Beckman公司,美國(guó))。清晨空腹采集靜脈血,檢測(cè)所有入選者的心肌酶、血糖以及血脂等。超敏C反應(yīng)蛋白(hs-CRP)采用免疫投射比濁法進(jìn)行檢測(cè),galectin-3采用雙抗體夾心酶標(biāo)法進(jìn)行檢測(cè)。
1.3統(tǒng)計(jì)學(xué)處理采用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。計(jì)量數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差(x±s)形式表示,組間比較采用t檢驗(yàn)和χ2檢驗(yàn)。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2.1Galectin-3、hs-CRP水平比較UA組患者的galectin-3、hs-CRP水平明顯高于比SA組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);UA組和SA組患者的galectin-3、hs-CRP水平均明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。見表2。
表2 3組患者galectin-3、hs-CRP水平的比較(x±s)
注:與對(duì)照組比較aP<0.01;與SA組比較bP<0.05。UA組:不穩(wěn)定型心絞痛組,SA組:穩(wěn)定型心絞痛組,galectin-3:半乳凝素-3,hs-CRP:超敏C反應(yīng)蛋白
2.2Galectin-3在UA診斷中的價(jià)值用ROC曲線分析galectin-3對(duì)UA患者的診斷價(jià)值發(fā)現(xiàn),該曲線下的面積是0.902,診斷敏感性為82.22%,特異性為87.67%。注:ROC曲線下面積>0.9表示該指標(biāo)診斷準(zhǔn)確性較高;0.7~0.9表示其診斷準(zhǔn)確性一般;0.5~0.7表示其診斷價(jià)值較低;低于0.5則表示該指標(biāo)不具有診斷價(jià)值。
注:galectin-3:半乳凝素-3,UA:不穩(wěn)定型心絞痛圖1 galectin-3對(duì)UA的診斷價(jià)值ROC曲線圖
UA是一種急性冠狀動(dòng)脈綜合征(ACS)的臨床表現(xiàn),其病情惡化會(huì)進(jìn)一步演變?yōu)榧毙孕募」K?AMI),嚴(yán)重者甚至?xí)?,此外UA還會(huì)演變成SA[4]。UA的主要臨床特征包括起病急、病情不穩(wěn)定、癥狀在短期內(nèi)會(huì)反復(fù)發(fā)作等,這與缺血性刺激短期內(nèi)任意消長(zhǎng)以及突然出現(xiàn)有關(guān)[5]。UA發(fā)病機(jī)制主要是不穩(wěn)定斑塊內(nèi)皮侵蝕或破裂后局部出現(xiàn)非閉塞性血栓所致[6]。
Galectin-3是最近新發(fā)現(xiàn)的有著嵌合體結(jié)構(gòu)的一名半乳凝素家族成員,屬于非抗體蛋白,其參與過敏性以及急、慢性炎癥過程,是一種新發(fā)現(xiàn)的炎癥介質(zhì)[7]。galectin-3的作用機(jī)制主要是通過對(duì)細(xì)胞-細(xì)胞基質(zhì)間整合素表達(dá)的改變以及粘附一定的基質(zhì)來調(diào)控信號(hào)的傳導(dǎo),其可以參與免疫應(yīng)答、炎癥反應(yīng)以及細(xì)胞粘附、分化、凋亡、生長(zhǎng)等過程;與多種疾病(如腫瘤、肝硬化等)關(guān)系密切[8]。Galectin-3表達(dá)于多種炎癥或免疫細(xì)胞中,如肥大細(xì)胞、單核細(xì)胞以及NK細(xì)胞等[9]。galectin-3有一定的促炎癥作用,主要表現(xiàn)為使單核細(xì)胞趨化,加快巨噬細(xì)胞的游走;對(duì)單核細(xì)胞和中性粒細(xì)胞的活化起促進(jìn)作用;促進(jìn)內(nèi)皮細(xì)胞、層黏連蛋白和中性粒細(xì)胞的粘附;對(duì)肥大細(xì)胞的炎癥介質(zhì)的釋放起誘導(dǎo)作用[10]。巨噬細(xì)胞是galectin-3的主要來源,galectin-3對(duì)巨噬細(xì)胞起正性調(diào)節(jié)的作用,其通過各種形式將巨噬細(xì)胞激活,同時(shí)對(duì)其在粥樣硬化斑塊中的聚集部位可以進(jìn)行良好地標(biāo)記[11]。本研究結(jié)果顯示,與SA組、對(duì)照組相比,UA組的galectin-3水平明顯上升,究其原因可能與其在不穩(wěn)定斑塊局部、器官的血供以及組織內(nèi)擁有較多的已被激活的內(nèi)皮細(xì)胞、平滑肌細(xì)胞以及巨噬細(xì)胞等相關(guān),說明galectin-3參與了斑塊由穩(wěn)定性向不穩(wěn)定性轉(zhuǎn)換以及斑塊形成的整個(gè)過程[12]。有研究發(fā)現(xiàn)[13],動(dòng)脈粥樣硬化的動(dòng)物模型中g(shù)alectin-3的泡沫細(xì)胞濃度明顯上升,細(xì)胞表面galectin-3參與了整個(gè)低密度脂蛋白(LDL)的胞吞以及泡沫細(xì)胞的形成過程,對(duì)斑塊中的巨噬細(xì)胞的泡沫化以及聚集起促進(jìn)作用,提示galectin-3與斑塊的形成有著密切的關(guān)系,是斑塊穩(wěn)定狀態(tài)的一個(gè)重要指標(biāo)。此外,本研究還發(fā)現(xiàn),UA組和SA組的galectin-3水平差異顯著,而hs-CRP水平也存在一定的差異,提示在UA的診斷以及不穩(wěn)定性斑塊的判斷方面,galectin-3比hs-CRP的準(zhǔn)確性更高,考慮可能與兩者不同的來源有關(guān)。ROC曲線下面積為0.902,提示galectin-3在UA的診斷中準(zhǔn)確性較高。
綜上所述,hs-CRP、galectin-3與斑塊的不穩(wěn)定性有關(guān),能對(duì)冠狀動(dòng)脈粥樣硬化斑塊的不穩(wěn)定性進(jìn)行間接反映,在對(duì)UA的診斷上galectin-3的準(zhǔn)確性相對(duì)更高,具有較好的臨床應(yīng)用價(jià)值。
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(本文編輯:王映紅)
Detection value of galectin-3 in the patients with unstable angina pectoris
WuYuntao,HongChunrong
(HuayangStreetCommunityHealthServiceCenter,ChangningDistrict,Shanghai200042,China)
ObjectiveTo explore the clinical value of galectin-3 in the diagnosis of unstable angina pectoris (UA).Methods Clinical data of 48 patients with unstable angina pectoris and 38 patients with stable angina pectoris (SA), who received treatment at our hospital from October, 2014 to October, 2015, were analyzed retrospectively. The medical data of another 38 healthy people who had routine health checks at our hospital at the same period were chosen as the control group. The general medical data and the expression levels of galectin-3 and hs-CRP were compared between the 3 groups, and then the diagnostic value of galectin-3 in the diagnosis of UA was analyzed by the ROC curve.ResultsNo statistical significance could be noted in the medical data concerning age and gender, when comparisons were made between the 3 groups(P>0.05). The levels of galectin-3 and hs-CRP in the patients of the UA group were obviously higher than those in the SA group (P<0.01). Furthermore, the levels of galectin-3 and hs-CRP in the patients of the UA group and the SA group were all significantly higher than those of the control group, and statistical significance could be noted, when comparisons were made between the 3 groups (P<0.01). For the diagnostic value of galectin-3 on UA patients, ROC curve analysis indicated that the area under the curve was 0.89.Conclusiongalectin-3 and hs-CRP could indirectly reflect the stability of plaque, and galectin-3 was more accurate in the diagnosis of unstable angina pectoris.
Unstable angina pectoris; Stable angina pectoris; galectin-3; hs-CRP
單位]200042上海,長(zhǎng)寧區(qū)華陽街道社區(qū)衛(wèi)生服務(wù)中心
洪春榮,電子信箱:huayangzkk@163.com
R541.4
A
10.3969/j.issn.1009-0754.2016.04.010
2016-01-12)