Correlation among PGRN, MCP-1 and CDC42 in serum and the degree of vascular lesions in patients with acute myocardial infarction in Xining region
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摘要: 目的 分析西宁地区急性心肌梗死(AMI)患者血清颗粒蛋白前体(progranulin，PGRN)、单核细胞趋化蛋白1(monocyte chemoattractant protein-1，MCP-1)、细胞分裂周期蛋白42(cell division cycle 42，CDC42)水平，及其与血管病变程度的相关性。 方法 收集2022年7月—2023年12月在青海省人民医院心血管内科住院的81例AMI患者为病例组，同期80例非冠心病患者为对照组。收集患者一般资料、实验室检查、心脏彩色超声等，酶联免疫吸附法测定各组血清PGRN、MCP-1、CDC42水平；多因素logistic回归分析AMI的危险因素。根据Gensini评分、冠状动脉(冠脉)病变支数及全球急性冠脉事件登记(GRACE)评分将AMI患者进行亚分组。分析各亚组PGRN、MCP-1、CDC42水平与血管病变程度的相关性。 结果 ① 与对照组比较，AMI组的血清PGRN、MCP-1水平升高(P＜0.05)，CDC42水平降低(P＜0.05)；②不同冠脉狭窄程度的血清PGRN、MCP-1、CDC42均有统计学差异(P＜0.05)；③不同冠脉血管病变支数的血清PGRN、MCP-1、CDC42均有统计学差异(P＜0.05)；④不同GRACE评分组的血清PGRN、MCP-1、CDC42均无统计学差异；⑤AMI组中PGRN、MCP-1与Gensini评分、病变支数均呈正相关(P＜0.05)，与GRACE评分无相关；而AMI组CDC42与Gensini评分、病变支数呈负相关(P＜0.05)，与GRACE评分无相关；⑥Logistic回归分析示，PGRN、MCP-1是AMI的独立危险因素(P＜0.05)。 结论 血清PGRN、MCP-1与Gensini评分、冠脉病变支数呈正相关，CDC42与Gensini评分、冠脉病变支数呈负相关。PGRN、MCP-1是AMI发生的独立危险因素。
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关键词:
- 急性心肌梗死 /
- 血清颗粒蛋白前体 /
- 单核细胞趋化蛋白1 /
- 细胞分裂周期蛋白42 /
- 血管病变程度
Abstract: Objective To analyze serum progranulin(PGRN), monocyte chemoattractant protein-1(MCP-1) and cell division cycle 42(CDC42) levels were associated with the degree of vascular disease in patients with acute myocardial infarction(AMI) in Xining area. Methods The 81 patients with AMI hospitalized in the Cardiovascular Department of Qinghai Provincial People's Hospital from July 2022 to December 2023 were collected as the case group, and 80 patients without coronary heart disease were collected as the control group. General data, laboratory examination and heart color ultrasound were collected. Serum PGRN, MCP-1 and CDC42 levels were determined by enzyme-linked immunosorbent assay. Multivariate logistic regression was used to analyze the risk factors of AMI. Patients with AMI were subdivided according to Gensini score, number of coronary lesions, and Global Acute Coronary Event Registry(GRACE) score. The correlation between the levels of PGRN, MCP-1, CDC42 and the degree of vascular disease in each subgroup was analyzed. Results ① Compared with the control group, the serum levels of PGRN and MCP-1 in AMI group were increased(P < 0.05), and the level of CDC42 was decreased(P < 0.05); ② There were statistical differences in serum PGRN, MCP-1 and CDC42 in different degrees of coronary artery stenosis(P < 0.05); ③ The serum PGRN, MCP-1 and CDC42 were significantly different in different number of coronary vascular lesions(P < 0.05). ④ There were no significant differences in serum PGRN, MCP-1 and CDC42 among different GRACE groups. ⑤ In AMI group, PGRN and MCP-1 were positively correlated with Gensini score and number of lesions(P < 0.05), but not with GRACE score; In AMI group, CDC42 was negatively correlated with Gensini score and number of lesions(P < 0.05), but not with GRACE score. ⑥Logistic regression analysis showed that PGRN and MCP-1 were independent risk factors for AMI(P < 0.05). Conclusion Serum PGRN and MCP-1 were positively correlated with Gensini score and number of coronary lesions, while CDC42 was negatively correlated with Gensini score and number of coronary lesions. PGRN and MCP-1 were independent risk factors for AMI. -
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表 1 两组患者的一般临床资料比较
Table 1. Comparison of general clinical data between the two groups
X±S, 例(%) 指标 AMI组(81例) 对照组(80例) χ2/t P 年龄/岁 62.90±11.14 60.06±9.51 1.738 0.084 男性 55(67.9) 44(55.0) 2.310 0.129 吸烟史 38(46.9) 25(31.3) 3.154 0.061 饮酒史 11(13.6) 17(21.3) 1.157 0.282 高血压 53(65.4) 55(68.8) 0.028 0.868 糖尿病 34(42.0) 23(28.7) 2.527 0.112 钙通道阻滞剂 33(40.7) 38(47.5) 0.497 0.481 β受体阻滞剂 5(6.2) 11(13.8) 1.805 0.179 血管紧张素转换酶抑制剂 7(8.6) 16(20.0) 3.363 0.067 利尿剂 6(7.4) 7(8.8) 0.001 0.981 利血平 1(1.2) 1(1.3) 0.000 1.000 二甲双胍 8(9.9) 9(11.3) 0.001 0.978 胰岛素 10(12.3) 6(7.5) 0.584 0.445 阿卡波糖 3(3.7) 2(2.5) 0.000 1.000 他汀类药物 2(2.5) 1(1.3) 0.000 1.000 
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表 2 两组患者的实验室资料比较
Table 2. Comparison of the laboratory data between the two patient groups
X±S, M(P25, P75) 指标 AMI组(81例) 对照组(80例) t/Z P WBC/(×109/L) 9.73(8.07，12.15) 5.54(4.63，6.81) -9.562 ＜0.001 RBC/(×1012/L) 4.92(4.56，5.50) 4.77(4.37，5.04) -2.404 0.016 Hb/(g/L) 157.00(145.00，169.00) 143.50(135.25，157.50) -3.404 ＜0.001 NEUT/(×109/L) 7.28(6.08，9.11) 3.16(2.57，4.13) -10.165 ＜0.001 LYM/(×109/L) 1.36(0.97，2.04) 1.73(1.40，2.16) -3.302 ＜0.001 PLT/(×109/L) 190.00(150.00，235.00) 180.50(149.50，214.75) -1.035 0.301 hs-CRP/(mg/dL) 0.92(0.20，1.86) 0.12(0.05，0.27) -6.578 ＜0.001 TG/(mmol/L) 1.57(1.00，2.00) 1.51(0.99，2.25) -0.377 0.706 TC/(mmol/L) 4.46±1.20 4.38±1.02 0.456 0.649 LDL-C/(mmol/L) 2.68±0.81 2.57±0.79 0.853 0.395 HDL-C/(mmol/L) 0.99±0.27 1.06±0.26 -1.712 0.089 HbA1c/% 6.17(5.62，7.66) 5.74(5.53，6.18) -2.641 0.008 ALT/(U/L) 31.00(21.00，41.00) 18.50(13.00，29.75) -4.129 ＜0.001 AST/(U/L) 45.00(25.50，92.50) 20.50(17.00，28.00) -6.744 ＜0.001 cTnI/(pg/mL) 10 968.60(1 483.20，26 406.00) 2.30(1.45，3.50) -10.909 ＜0.001 CK-MB/(U/L) 64.00(28.50，147.00) 9.00(7.00，10.75) -10.204 ＜0.001 Cr/(μmol/L) 82.00(74.50，92.00) 76.00(66.25，83.00) -3.846 ＜0.001 UA/(μmol/L) 357.00(296.00，447.50) 327.00(286.50，397.50) -2.042 0.041
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表 3 两组患者的心脏彩色超声比较
Table 3. Comparison of cardiac color ultrasound in the two groups
M(P25, P75) 指标 AMI组(81例) 对照组(80例) Z P LAD/mm 38.00(36.00，42.50) 35.00(32.00，37.75) -4.696 ＜0.001 LVEDD/mm 50.00(46.00，55.00) 46.00(44.00，48.00) -4.720 ＜0.001 IVST/mm 10.00(9.00，11.00) 10.00(9.00，10.00) -2.126 0.034 LVPWT/mm 10.00(9.00，11.00) 10.00(9.00，10.00) -2.097 0.036 LVEF/% 57.00(49.00，61.00) 66.00(63.00，69.00) -8.019 ＜0.001
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表 4 两组PGRN、MCP-1、CDC42水平比较
Table 4. Comparison of PGRN, MCP-1, and CDC42 levels between the two groups
M(P25, P75) 指标 AMI组(81例) 对照组(80例) Z P PGRN/(pg/mL) 239.20(182.10，343.73) 126.24(51.80，202.01) -6.308 ＜0.001 MCP-1/(pg/mL) 131.55(52.92，223.78) 32.47(19.62，89.87) -6.312 ＜0.001 CDC42/(ng/mL) 1.10(0.64，1.70) 1.20(0.79，2.35) -2.148 0.032
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表 5 不同Gensini评分组别AMI患者的PGRN、MCP-1和CDC42的比较
Table 5. comparison of PGRN, MCP-1 and CDC42 in patients with AMI in different Gensini score groups
M(P25, P75) 指标 轻度狭窄组(16例) 中度狭窄组(38例) 重度狭窄组(27例) H P PGRN/(pg/mL) 172.09(108.18，216.76) 232.76(182.54，296.13)1) 330.42(230.71，427.67)1)2) 18.882 ＜0.001 MCP-1/(pg/mL) 44.53(30.22，114.95) 125.79(68.84，188.42)1) 184.52(130.36，325.86)1)2) 20.622 ＜0.001 CDC42/(ng/mL) 1.80(1.43，1.94) 1.11(0.73，1.59)1) 0.61(0.38，1.11)1)2) 13.038 0.001 与轻度狭窄组比较，1)P＜0.05；与中度狭窄组比较，2)P＜0.05。
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表 6 不同冠脉血管病变支数AMI患者的PGRN、MCP-1和CDC42的比较
Table 6. comparison of PGRN, MCP-1 and CDC42 in patients with AMI with different coronary vascular lesions
M(P25, P75) 指标 单支病变组(41例) 双支病变组(29例) 3支病变组(11例) H P PGRN/(pg/mL) 185.60(147.53，225.83) 280.88(238.22，336.48)1) 427.67(360.42，465.86)1)2) 36.609 ＜0.001 MCP-1/(pg/mL) 66.12(40.10，111.54) 169.80(143.07，245.79)1) 340.09(322.69，373.13)1)2) 51.324 ＜0.001 CDC42/(ng/mL) 1.56(1.21，1.93) 0.86(0.61，1.09)1) 0.38(0.27，0.50)1)2) 43.209 ＜0.001 与单支病变组比较，1)P＜0.05；与双支病变组比较，2)P＜0.05。
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表 7 不同GRACE评分组别AMI患者的PGRN、MCP-1和CDC42的比较
Table 7. comparison of PGRN, MCP-1, and CDC42 in AMI patients for the different GRACE score groups
M(P25, P75) 指标 低风险组(21例) 中风险组(36例) 高风险组(24例) H P PGRN/(pg/mL) 225.35(163.14，307.66) 226.32(184.69，353.94) 263.22(198.19，360.42) 1.551 0.460 MCP-1/(pg/mL) 109.71(50.90，222.05) 130.26(49.17，158.36) 191.65(81.98，251.15) 3.721 0.156 CDC42/(ng/mL) 1.11(0.88，1.75) 1.13(0.64，1.82) 0.86(0.58，1.40) 2.301 0.317
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表 8 AMI组中PGRN、MCP-1、CDC42与cTNI、CK-MB、病变支数、GRACE评分的相关性分析
Table 8. PGRN, MCP-1, CDC42 and cTNI, CK-MB, and lesion branch in the AMI group Correlation analysis of the number and GRACE scores
指标 PGRN MCP-1 CDC42 rs P rs P rs P cTnI 0.509 ＜0.001 0.403 ＜0.001 -0.056 0.479 CK-MB 0.469 ＜0.001 0.441 ＜0.001 -0.117 0.140 Gensini评分 0.483 ＜0.001 0.501 ＜0.001 -0.514 ＜0.001 GRACE评分 0.138 0.220 0.152 0.175 -0.151 0.177 病变支数 0.670 ＜0.001 0.799 ＜0.001 -0.733 ＜0.001
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表 9 AMI的单因素logistic回归分析
Table 9. Univariate analysis of the AMI
因素 B SE Wald值 P OR(95%CI) WBC 1.075 0.169 40.334 ＜0.001 2.930(2.103~4.082) RBC 0.603 0.252 5.703 0.017 1.827(1.114~2.995) Hb 0.024 0.008 8.453 0.004 1.025(1.008~1.041) NEUT 1.533 0.252 37.078 ＜0.001 4.634(2.829~7.590) hs-CRP 0.669 0.220 9.257 0.002 1.952(1.269~3.004) ALT 0.018 0.008 4.660 0.031 1.018(1.002~1.034) AST 0.046 0.011 18.853 ＜0.001 1.047(1.025~1.069) HbA1c 0.366 0.132 7.729 0.005 1.443(1.114~1.868) Cr 0.055 0.014 14.558 ＜0.001 1.056(1.027~1.086) UA 0.004 0.002 5.046 0.025 1.004(1.001~1.007) PGRN 0.007 0.002 19.889 ＜0.001 1.007(1.004~1.010) MCP-1 0.010 0.002 19.682 ＜0.001 1.010(1.006~1.014) CDC42 -0.549 0.173 10.110 0.001 0.578(0.412~0.810)
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表 10 AMI多因素logistic回归分析
Table 10. Multivariate logistic regression analysis of AMI
因素 B SE Wald值 P OR(95%CI) AST 0.092 0.043 4.673 0.031 1.097(1.009~1.193) PGRN 0.007 0.003 4.537 0.033 1.007(1.001~1.014) MCP-1 0.012 0.004 7.724 0.005 1.012(1.004~1.021) 常量 -21.855 6.866 10.131 0.001 ＜0.001
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