Relationship between plasma von Willebrand factor lyase and cardiac function in patients with acute ST segment elevation myocardial infarction
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摘要: 目的:探讨急性ST段抬高型心肌梗死(STEMI)患者血浆血管性血友病因子裂解酶(ADAMTS13)水平与心功能的关系。方法:纳入2018年4月1日-2019年3月1日在新疆维吾尔自治区人民医院心内科住院并且行冠状动脉造影检查的急性STEMI患者143例(STEMI组),另纳入冠状动脉造影未见明显异常的患者143例(对照组)。采用双抗体夹心酶联免疫吸附法(ELISA)检测血浆ADAMTS13水平和血管性血友病因子(VWF)水平。根据Killip心功能分级,将STEMI组患者分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级4组,比较不同心功能分级组血浆ADAMTS13、VWF、高敏C反应蛋白(hs-CRP)、左室射血分数(LVEF)及血清脑钠肽(BNP)水平。通过二分类Logistic回归筛选STEMI的影响因素。结果:①STEMI组血浆ADAMTS13水平显著低于对照组[(1 136.51±136.62) ng/m︰(2 153.32±291.81) ng/ml,P<0.001]。②KillipⅢ级、Ⅳ级患者血浆ADAMTS13与VWF水平均显著高于KillipⅠ级、Ⅱ级患者(均P<0.05),而KillipⅠ级和Ⅱ级患者间比较差异无统计学意义。③二分类Logistic回归分析结果显示,控制混杂因素后,VWF(OR=1.006,P<0.05)、hs-CRP(OR=1.096,P<0.05)与BNP(OR=1.001,P<0.05)是STEMI的危险因素,而ADAMTS13(OR=0.49,P<0.05)与LVEF(OR=0.88,P<0.05)是保护因素。结论:STEMI患者血浆ADAMTS13水平明显升高,且急性期Killip心功能分级越高,ADAMTS13水平上升越明显。高水平的血浆ADAMTS13可能是STEMI患者心功能的保护因素。
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关键词:
- 急性ST段抬高型心肌梗死 /
- 血管性血友病因子裂解酶 /
- 血管性血友病因子 /
- 心功能
Abstract: Objective:To investigate the relationship between plasma levels of von Willehemophilia factor lyase(ADAMTS13) and cardiac function in patients with acute ST segment elevation myocardial infarction(STEMI).Method:A total of 143 patients with acute STEMI hospitalized in the Department of Cardiology,People's Hospital of Xinjiang Uygur Autonomous Region and underwent coronary angiography from April 1,2018 to March 1,2019 were included in the STEMI group,and other 143 patients without obvious abnormality indicated by coronary angiography were included into the control group.Plasma ADAMTS13 and von Willebrand factor(VWF) levels were measured by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).According to Killip cardiac function classification,patients with STEMI were divided into four groups:grade Ⅰ,Ⅱ,Ⅲ,Ⅳ.The levels of plasma ADAMTS13,VWF,high sensitive C-reactive protein(hs-CRP),left ventricular ejection fraction(LVEF),and brain natriuretic peptide(BNP) were compared among groups with different Killip grades.The influencing factors of STEMI were screened by binary Logistic regression analysis.Result:①The level of plasma ADAMTS in the STEMI group was lower than that in the control group [(1 136.51 ±136.62) ng/m vs(2 153.32 ±291.81) ng/ml,P<0.001].②The levels of plasma ADAMTS13 and VWF in patients with Killip grade Ⅲ and Ⅳ were higher than those in grade Ⅰand Ⅱ(all P<0.05),while the difference between in grade Ⅰ and Ⅱ was no significant.③Logistic regression analysis showed that VWF(OR= 1.006,P<0.05),hs-CRP(OR=1.096,P<0.05) and BNP(OR=1.001,P<0.05) were risk factors of STEMI,while ADAMTS13(OR=0.49,P<0.05) and LVEF(OR= 0.88,P<0.05) were protective factors.Conclusion:The level of ADAMTS13 is significantly increased in patients with STEMI,and the higher the Killip grade is,the more obvious the level of ADAMTS13 increase is.The high level of plasma ADAMTS13 may be a protective factor for cardiac function in STEMI patients. -
[1] 胡盛寿,高润霖,刘力生,等.《中国心血管病报告2018》概要[J].中国循环杂志,2019,34(3):209-220.
[2] Bajaj A,Sethi A,Rathor P,et al.Acute complications of myocardial infarction in the current era:diagnosis and management[J].Investig Med,2015,63(7):844-855.
[3] Witsch T,Martinod K,Sorvillo N,et al.Recombinant human ADAMTS13 treatment improves myocardial remodeling and functionality after pressure overload injury in mice[J].Am Heart Assoc,2018,7(3):e007004.
[4] Koupenova M,Clancy L,Corkrey HA,et al.Circulating platelets as mediators of immunity,inflammation,and thrombosis [J].Circ Res.(2018)122:337-351.
[5] Maino A,Siegerink B,Lotta LA,et a1.Plasma ADAMTS-13 levels and the risk of myocardial infarction:an individual patient data meta-analysis [J].Thromb Haemost,2015,13(8):1396-1404.
[6] Masias C,Cataland SR.The role of ADAMTS13 testing in the diagnosis and management of thrombotic microangiopathies and thrombosis[J].Blood,2018,132(9):903-910.
[7] Matevosyan K,Sarode R.Thrombosis,microangiopathies,and inflammation[J].Semin Thromb Hemost,2015,41(6):556-562.
[8] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.2015急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[9] Haegele S,Fuxsteiner J,Pereyra D,et al.Elevated ADAMTS13 activity is associated with poor postoperative outcome in patients undergoing liver resection[J].Sci Rep,2018,8(1):16823.
[10] 周青,李剑,罗心平,等.血管性血友病因子和ADAMTS-13水平与急诊冠状动脉支架置入术后冠状动脉血流的关系[J].中华心血管病杂志,2011,39(3):212-216.
[11] Pedrazzini G,Biasco L,Sulzer I,et al.Acquired intracoronary ADAMTS13 deficiency and VWF retention at sites of critical coronary stenosis in patients with STEMI[J].Blood,2016,127(3):2934-2936.
[12] De Meyer SF,Savchenko AS,Haas MS,et al.Protective anti-inflammatory effect of ADAMTS13 on myocardial ischemia/reperfusion injury in mice[J].Blood,2012,120(26):5217-5223.
[13] Sonneveld MAH,Franco OH,Ikram MA,et al.Von Willebrand factor,ADAMTS13,and the risk of mortality:The Rotterdam Study[J].Arterioscler Thromb Vasc Biol,2016,36(12):2446-2451.
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