血清TGF-βl水平和冠心病临床关系研究

【摘要】目的 探讨冠心病（CHD）不同临床类型患者外周血清中转化生长因子β1（TGF-β1）水平并结合选择性冠状动脉造影术结果的分析，探讨它与冠状动脉粥样斑块程度和稳定性的关系，以期对TGF-β1在CHD发病机理中的作用进行研究。方法 选择我科住院的CHD患者72例，按临床症状分为亚组急性冠脉综合征(ACS)44例，稳定型心绞痛（SAP）28例。并经冠脉造影（CAG）证实。对照组15例，并常规行冠脉造影排除冠心病。采用ELISA法测定血清TGF-β1的水平。根据CAG术结果将CHD组分为三个亚组:单支病变、双支病变和三支病变，左主干病变归为双支病变亚组。血管狭窄的部位由目测确定，以狭窄≥50%计病变冠脉支数。应用SYNTAX评分标准（运用从SYNTAX官方网站所下载的SYNTAX评分计算）。结果  CHD患者血清TGF-β1水平均显著低于对照组，分别为21012.3±13704.1 pg/ml、52120.6±27424.0 pg/ml。（P<0.05）。ACS患者血清TGF-β1水平均显著低于SAP组, 29695.0±20561.3 pg/ml,21012.3±13704.1 pg/ml,差异有显著性 (P<0.05)。CHD患者血清TGF-β1与冠脉病变积分、病变冠脉支数呈负相关，随着血清TGF-β1浓度相应降低，冠脉病变积分、病变冠脉支数值相应增加，差异有显著性。结论 本临床试验结果倾向于血清TGF-β1在CHD患者中以保护性作用为主。血清TGF-β1利于稳定冠心病患者的症状，减少ACS的发生；血清TGF-β1水平与慢性冠状动脉粥样硬化斑块的形成密切相关。
【关键词】  TGF-β1  冠心病  急性冠脉综合征  不稳定型心绞痛 
【Abstract】Objects  Detected TGF-β1 in the serum level of coronary heart disease, and  analysis correlation of its relevance, explore it with coronary artery atherosclerosis plaques degree and stability of the relationship, in order to study TGF beta-1 in the role of CHD pathogenesis. Methods  1. Study gruop included coronary heart disease and control subjects.Experiment gruop were divided into 2 groups : stable angina pectoris(SAP) group and acute coronary syndrome(ACS) group.72 cases with CHD were collected from the Department of Cardiology, Panzhihua NO.2 People’s Hospital, and confirmed by coronary angiography (at least 1 vessel stenosis ≥ 50%). The serum TGF-β1 was measured by Enzyme-linked immunosorbent assay (ELISA) method.We got the scores of coronary artery lesion according to the result of coronary angiography. Results 1．Serum level of TGF-β1in CHD group was significantly lower than control group (24388.9±17107.9pg/ml vs 52120.6±27424.0 pg/ml, p<0. 05); TGF-β1 level in ACS group was significantly lower than SAP group (21012.3±13704.1 pg/ml vs 29695.0±20561.3 pg/ml, p<0.05);2. the TGF-β1 level of people with at least one vessel disease was lower than that of people in control group. the TGF-β1 level of people with triple vessel disease was lower than that of people with single vessel disease. (27678.4±17434.1 pg/ml vs 18288.7±12518.6 pg/ml ,P<0.05）3.The concentration of serum TGF-β1 showed an inverse correlation with result of coronary  angiography(CAG) in subjects.Conclusion1. High level of serum TGF-β1 in patients with coronary heart disease may play a protective role, and has the effect of anti-atherosclerosis and anti-inflammatory.it can prevent the development of coronary heart disease.2. The serum of TGF-β1 levels in patients with CHD were negatively related to the number of diseased coronary vessels. The more level of TGF-β1 in serum of patients with coronary heart disease, the beter clinical outcome. TGF-β1 might be a kind of  protective cytokine for CHD.