热休克蛋白60、65对急性冠脉综合征合并糖尿病患者近期预后的影响
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摘要
目的:探讨入院即刻血清中人热休克蛋白60(HSP60)、热休克蛋白65(HSP65)检测在反映糖尿病合并冠心病患者病情程度中的作用,分析其与冠心病其他危险因素之间的关系,并重点讨论人HSP60、HSP65在糖尿病合并急性冠脉综合征(ACS)患者近期预后中的作用。
方法:从南京医科大学附属无锡市人民医院2009年11月到2010年5月心内科住院患者中人选89例糖尿病患者作为研究对象,分为ACS组、稳定性心绞痛(SAP)组、无冠心病(non-CHD)组。所有患者均行冠脉造影术明确病变程度。建立调查表收集资料,记录所有患者的一般临床资料及生化检查,测定左室射血分数、脑钠肽。应用酶联免疫吸附分析方法测定所有患者入院即刻血清中人HSP60、HSP65含量。并对所有患者建立随访记录,观察半年内心血管事件的发生情况,并分析其与HSP60、HSP65之间的关系。
结果:1. ACS组血清人HSP60与HSP65的含量均较SAP组及non-CHD组均增高(P<0.05)。SAP组血清中HSP60含量与non-CHD组无明显差异,但SAP组人血清HSP65含量比non-CHD组明显增高(P<0.05)。2.与其他反映冠心病病情程度指标的相关性研究发现,人血清HSP60、HSP65含量均与入院即刻BNP、肌酸激酶同工酶、谷草转氨酶、乳酸脱氢酶、Gensini积分呈正相关关系(P<0.05),与左室射血分数呈负相关关系(P<0.05)。HSP60与HSP65之间也呈正相关关系(r=0.691, P<0.001)。3.血清中HSP60及HSP65含量不受冠心病的常规危险因素如年龄、性别、血压、饮酒、体重指数及血脂水平等影响。但吸烟可以影响血清中HSP60含量而不影响HSP65含量,目前正在吸烟者血清中人HSP60含量明显高于从不吸烟者(P<0.05)。4.随访结果:成功随访86例,失访3例。半年内有心血管事件发生的患者共17例,血清中HSP60与HSP65的含量均明显高于无心血管事件发生的患者(P<0.05),ACS组内血清中HSP60与HSP65的含量亦均明显高于无心血管事件发生的患者(P<0.05),COX回归分析可见HSP65为糖尿病合并急性冠脉综合征患者半年内是否发生心血管事件的独立预测因子(P=0.036)。
结论:人HSP60、HSP65检测在糖尿病合并冠心病中具有重要的价值,都可以作为反映病情程度及预后的指标,其中HSP65是预测糖尿病合并急性冠脉综合征患者近期心血管事件发生的独立危险预测因子。
Objective To analysis the effect of heat shock protein 60 (HSP60) and heat shock protein 65 (HSP65) on reaction of the severity of diabetic patients with coronary heart disease (CHD) at the time of admission, and to investigate the relationship between HSP60, HSP65 and other risk factors with CHD. And focus on discussion the role of short-term prognosis about human HSP60, HSP65 in diabetic patients with acute coronary syndrome (ACS).
Methods 89 cases of hospitalized patients with diabetes were collected from department of cardiovascular disease, Wuxi People's Hospital affiliated to Nanjing Medical University from November 2009 to May 2010, which were divided into ACS group, stable angina pectoris (SAP) group and non-CHD group. All patients underwent coronary angiography. Patient’s information was collected in questionnaire, which contained all the clinical data of patients, biochemical tests, left ventricular ejection fraction and brain natriuretic peptide. Immediately HSP60, HSP65 levels in human serum were measured in all patients with enzyme-linked immunosorbent assay at the time of admission. And established follow-up records of all patients to observe the recent occurrence of cardiovascular events, discussed the relationship between HSP60, HSP65 and coronary events in 6 months.
Results 1. HSP60 and HSP65 in ACS group were all significantly higher than SAP group and non-CHD group (P<0.05). HSP60 had no significantly difference between SAP group and non-CHD group, but HSP65 had higher level in SAP group than non-CHD group (P<0.05). 2. Correlations between HSP60, HSP65 and other index which could react the severity of CHD showed, there were positive correlation between HSP60,HSP65 and brain natriuretic peptide (BNP), creatine kinase MB, aspartate aminotransferase, lactate dehydrogenase, Gensini points(P <0.05), and negative correlation with left ventricular ejection fraction(LVEF)(P <0.05). And we found there had positive correlation between HSP60 and HSP65 (r=0.691, P<0.001).
3. Conventional risk factors of CHD such as age, sex, blood pressure, alcohol consumption, body mass index and blood lipid levels had no effect on HSP60 and HSP65 levels in serum. However, we found smoking can affect the levels of HSP60 without HSP65, HSP60 was significantly higher in the patients with current smoking than never smokers (P <0.05). 4. Follow-up results: 86 cases were of successful follow-up, lost in 3 cases. 17 cases of patients had cardiovascular events within six months, the serum content of HSP60 and HSP65 were significantly higher in patients with cardiovascular events than without cardiovascular events (P <0.05). COX regression analysis showed that HSP65 was an independent risk factor for cardiovascular events in 6 months in patients with diabetes and ACS (P = 0.036). Conclusions Detection of HSP60 and HSP65 in patients with diabetes and CHD had important value, they can be used as biochemical indexes in reaction the severity and prognosis of disease. HSP65 was an independent risk predictor of diabetic patients with ACS in recent cardiovascular events.
方法:从南京医科大学附属无锡市人民医院2009年11月到2010年5月心内科住院患者中人选89例糖尿病患者作为研究对象,分为ACS组、稳定性心绞痛(SAP)组、无冠心病(non-CHD)组。所有患者均行冠脉造影术明确病变程度。建立调查表收集资料,记录所有患者的一般临床资料及生化检查,测定左室射血分数、脑钠肽。应用酶联免疫吸附分析方法测定所有患者入院即刻血清中人HSP60、HSP65含量。并对所有患者建立随访记录,观察半年内心血管事件的发生情况,并分析其与HSP60、HSP65之间的关系。
结果:1. ACS组血清人HSP60与HSP65的含量均较SAP组及non-CHD组均增高(P<0.05)。SAP组血清中HSP60含量与non-CHD组无明显差异,但SAP组人血清HSP65含量比non-CHD组明显增高(P<0.05)。2.与其他反映冠心病病情程度指标的相关性研究发现,人血清HSP60、HSP65含量均与入院即刻BNP、肌酸激酶同工酶、谷草转氨酶、乳酸脱氢酶、Gensini积分呈正相关关系(P<0.05),与左室射血分数呈负相关关系(P<0.05)。HSP60与HSP65之间也呈正相关关系(r=0.691, P<0.001)。3.血清中HSP60及HSP65含量不受冠心病的常规危险因素如年龄、性别、血压、饮酒、体重指数及血脂水平等影响。但吸烟可以影响血清中HSP60含量而不影响HSP65含量,目前正在吸烟者血清中人HSP60含量明显高于从不吸烟者(P<0.05)。4.随访结果:成功随访86例,失访3例。半年内有心血管事件发生的患者共17例,血清中HSP60与HSP65的含量均明显高于无心血管事件发生的患者(P<0.05),ACS组内血清中HSP60与HSP65的含量亦均明显高于无心血管事件发生的患者(P<0.05),COX回归分析可见HSP65为糖尿病合并急性冠脉综合征患者半年内是否发生心血管事件的独立预测因子(P=0.036)。
结论:人HSP60、HSP65检测在糖尿病合并冠心病中具有重要的价值,都可以作为反映病情程度及预后的指标,其中HSP65是预测糖尿病合并急性冠脉综合征患者近期心血管事件发生的独立危险预测因子。
Objective To analysis the effect of heat shock protein 60 (HSP60) and heat shock protein 65 (HSP65) on reaction of the severity of diabetic patients with coronary heart disease (CHD) at the time of admission, and to investigate the relationship between HSP60, HSP65 and other risk factors with CHD. And focus on discussion the role of short-term prognosis about human HSP60, HSP65 in diabetic patients with acute coronary syndrome (ACS).
Methods 89 cases of hospitalized patients with diabetes were collected from department of cardiovascular disease, Wuxi People's Hospital affiliated to Nanjing Medical University from November 2009 to May 2010, which were divided into ACS group, stable angina pectoris (SAP) group and non-CHD group. All patients underwent coronary angiography. Patient’s information was collected in questionnaire, which contained all the clinical data of patients, biochemical tests, left ventricular ejection fraction and brain natriuretic peptide. Immediately HSP60, HSP65 levels in human serum were measured in all patients with enzyme-linked immunosorbent assay at the time of admission. And established follow-up records of all patients to observe the recent occurrence of cardiovascular events, discussed the relationship between HSP60, HSP65 and coronary events in 6 months.
Results 1. HSP60 and HSP65 in ACS group were all significantly higher than SAP group and non-CHD group (P<0.05). HSP60 had no significantly difference between SAP group and non-CHD group, but HSP65 had higher level in SAP group than non-CHD group (P<0.05). 2. Correlations between HSP60, HSP65 and other index which could react the severity of CHD showed, there were positive correlation between HSP60,HSP65 and brain natriuretic peptide (BNP), creatine kinase MB, aspartate aminotransferase, lactate dehydrogenase, Gensini points(P <0.05), and negative correlation with left ventricular ejection fraction(LVEF)(P <0.05). And we found there had positive correlation between HSP60 and HSP65 (r=0.691, P<0.001).
3. Conventional risk factors of CHD such as age, sex, blood pressure, alcohol consumption, body mass index and blood lipid levels had no effect on HSP60 and HSP65 levels in serum. However, we found smoking can affect the levels of HSP60 without HSP65, HSP60 was significantly higher in the patients with current smoking than never smokers (P <0.05). 4. Follow-up results: 86 cases were of successful follow-up, lost in 3 cases. 17 cases of patients had cardiovascular events within six months, the serum content of HSP60 and HSP65 were significantly higher in patients with cardiovascular events than without cardiovascular events (P <0.05). COX regression analysis showed that HSP65 was an independent risk factor for cardiovascular events in 6 months in patients with diabetes and ACS (P = 0.036). Conclusions Detection of HSP60 and HSP65 in patients with diabetes and CHD had important value, they can be used as biochemical indexes in reaction the severity and prognosis of disease. HSP65 was an independent risk predictor of diabetic patients with ACS in recent cardiovascular events.
引文
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[1] Carper S, Duffy J, Gerner E. Heat shock proteins in thermotolerance and other cellular processes. Cancer Res 1987;47 (20):5249-55.
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