sTWEAK，hsCRP在急性冠脉综合征的表达及临床意义

Expression and clinical significance of sTWEAK and hsCRP in patients with acute coronary syndrome

摘要:

目的：通过检测急性冠脉综合征（acute coronary syndrome，ACS）患者可溶性肿瘤坏死因子样凋亡弱诱导因子（soluble tumor necrosis factor-like weak inducer of apoptosis，sTWEAK）血浆浓度和高敏 C反应蛋白（high sensitivity C-reaction protein，hsCRP）血清浓度，探讨sTWEAK、hsCRP对ACS诊断的临床价值。方法：收集2012年9月1日至2013年3月31在重庆医科大学附属第一医院心血管内科住院的ACS患者62例，其中男性47例（75.81%），年龄（66.06±9.89）岁，同时收集同期住院患者中冠脉造影或冠脉CT证实的稳定性心绞痛（stable angina pectoris，SAP）患者19例以及冠脉造影排除冠心病的患者（对照组）29 例。ACS组再分为ST段抬高性心肌梗死（ST-segment elevation myocardial infarction，STEMI），非 ST段抬高性心肌梗死（non ST-segment elevation myocardial infarction，NSTEMI）和不稳定性心绞痛（unstable angina pectoris，UAP）3个亚组，分别有11例，14例和37例。采用酶联免疫吸附法（enzyme linked immunosorbent assay，ELISA）检测患者 sTWEAK血浆浓度，免疫比浊法检测hsCRP血清浓度。统计分析 3 组患者和ACS 3个亚组间sTWEAK血浆浓度、hsCRP血清浓度是否存在差异，ACS组sTWEAK与 hsCRP、cTn的相关性，以及三支病变与非三支病变的差异。结果：①ACS组、SAP组和对照组sTWEAK血浆浓度分别为139.95（121.30，155.51）、93.21（84.37，114.08） ng/L和124.24（118.32，135.49） ng/L，显示ACS组较SAP组和对照组高（P=0.000，P=0.007），SAP 组较对照组低（P=0.000）。②3组hsCRP血清浓度分别为 2.29（0.84，9.77）、1.40（0.47，1.96） mg/L和 0.87（0.46，1.75） mg/L，显示ACS组较ASP组和对照组高（P=0.015，P=0.001），SAP组与对照组无统计学差异（P=0.62）。③ACS 3个亚组间 sTWEAK血浆浓度无统计学差异（P=0.41），STEMI组和NSTEMI组hsCRP血清浓度高于UAP组（P=0.001，P=0.027），STEMI 组与NSTEMI组hsCRP血清浓度无统计学差异（P=0.202）。④ACS组sTWEAK血浆浓度和hsCRP血清浓度无直线相关（P=0.462），hsCRP 与 cTn 呈正相关（r=0.578，P=0.000），三支病变组与非三支病变组的sTWEAK和hsCRP无统计学差异（P=0.533，P=0.569）。结论：sTWEAK血浆浓度、hsCRP血清浓度在ACS 患者中升高，对ACS的诊断具有一定价值。

Abstract:

Objective：To determine the concentration of plasma soluble tumor necrosis factor-like weak inducer of apoptosis（sTWEAK） and serum high-sensitive C-reaction protein（hsCRP） in patients with acute coronary syndrome（ACS） and to investigate their clinical significance in the diagasis of ACS. Methods：A total of 62 patients with ACS（47 males and 15 females，（66.06±9.89） years old） treated in the department of cardiovascular diseases of the First Affiliated Hospital of Chongqing Medical university from September 1st 2012 to March 31st 2013 were involved in this study；19 patients with stable angina pectoris（SAP） confirmed by coronary angiog－raphy or CT were also analyzed；29 patients without coronary heart disease（CHD）in this period were served as control group. The 62 ACS patients were divided into 3 subgroups：ST-segment elevation myocardial infarction（STEMI） group（n=11），non ST-segment el－evation myocardial infarction（NSTEMI）group（n=14） and unstable angina pectoris（UAP） group（n=37）. The plasma sTWEAK was measured by enzyme-linked immunosorbent assay（ELISA） while serum hsCRP was determined by immunoturbidimetry. The concentrations of plasma sTWEAK and serum hsCRP were compared among ACS，SAP and control groups and also among the subgroups of ACS. The correlation between plasma sTWEAK and serum hsCRP，serum cTn were analyzed and plasma sTWEAK and serum hsCRP were compared between ctriple vessel disease and non-triple vessel disease in ACS group. Results：①The plasma sTWEAK concentration in ACS（139.95（121.30，155.51） ng/L） was significantly higher than that in SAP group（93.21（84.37，114.08） ng/L） and control group（124.24（118.32，135.49） ng/L）（P=0.000，P=0.007），and it was lower in SAP group than in control group（P=0.007）. ②The serum hsCRP concentration was significantly higher in ACS group（2.29（0.84，9.77） mg/L） than that in SAP group（1.40（0.47，1.96） mg/L） and control group（0.87（0.46，1.75） mg/L）（P=0.015，P=0.001），and there was no significant difference between SAP and control group（P=0.62）. ③There was no statistical difference in plasma sTWEAK level among the three subgroups of ACS（P=0.41）. The serum hsCRP concentration was higher in STEMI and NSTEMI subgroups than in UAP group（P=0.001，P=0.027），but without significant differences（P=0.202）. ④There was no linear correlation between plasma sTWEAK and serum hsCRP concen－tration（P=0.462） while serum hsCRP and cTn were positively correlated（r=0.578，P=0.000） and there was no difference in the plasma sTWEAK and serum hsCRP concentration between triple vessel disease and non-triple vessel disease. Conclusions：Patients with ACS have higher plasma sTWEAK and serum hsCRP concentrations when compared with SAP and non-CHD，demonstrating that sTWEAK and hsCRP may be helpful biochemical markers in the diagnosis of ACS.