血管内皮细胞生长因子和血浆组织激肽释放酶与冠状动脉狭窄的相关性研究

目的:确定冠心病患者血浆中血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)和组织激肽释放酶(tissue kallikrein,TK)水平与冠脉狭窄程度的相关性?方法:根据冠状动脉血管造影结果将110例患者按冠脉狭窄程度分为4组:单支狭窄50%~69%组 (组1,n = 32)?单支狭窄70%~99%和(或)多支病变(每支狭窄50%~99%)组 (组2,n = 29)?单支或(和)多支完全闭塞组 (组3,n = 25)?正常无狭窄组 (对照组,n = 24)?ELISA法检测血浆中VEGF和TK的水平?结果:组1:TK水平为(1 900 ± 461) pg/ml,VEGF为(54.29 ± 23.22) pg/ml;组2:TK水平为(2 203 ± 268) pg/ml,VEGF为(63.00 ± 26.72) pg/ml;组3:TK水平为(4 823 ± 1005) pg/ml,VEGF为(71.27 ± 17.86) pg/ml;对照组:TK水平为(781 ± 63) pg/ml,VEGF为(54.75 ± 23.22) pg/ml?使用多元线性逐步回归分析显示血浆中VEGF水平与狭窄程度之间无显著相关性,而TK水平与狭窄程度之间存在显著的相关性(P < 0.001),且与高血压(P = 0.946)?糖尿病(P = 0.288)?吸烟 (P = 0.933)等危险因素无显著相关性?TK水平在1 725 pg/ml阈值处具有诊断冠状动脉完全梗塞最高的敏感性和特异性?结论:冠心病患者血浆中VEGF和TK等促血管新生因子均高表达,TK水平与冠状动脉狭窄程度显著独立相关,可作为反映冠状动脉狭窄严重程度的一项重要指标?

Correlation between vascular endothelial growth factor,plasma tissue kallikrein and coronary artery stenosis

Objective:To determine the association of plasma vascular endothelial growth factor(VEGF) and tissue kallikrein (TK) levels with coronary artery stenosis degree in coronary artery disease patients. Methods:According to coronary angiography,the patients were stratified as 50% to 69% stenosis in one artery (group 1,n = 32),70% to 99% stenosis in one artery and (or) 50% to 99% stenosis in two or three artery (group 2,n = 29),total occlusion in one and(or) multi-artery(group 3,n = 25) and no stenosis (control,n = 24). Plasma TK and VEGF concentrations were measured by ELISA. Results:TK augmented from (781 ± 63) pg/ml in no stenosis to (1 900 ± 461) pg/ml in group 1,(2 203 ± 268) pg/ml in group 2 and (4 823 ± 1 005) pg/ml in group 3. VEGF level was (54.75 ± 23.22) pg/ml in no stenosis,(54.29 ± 23.22) pg/ml in group 1,(63.00 ± 26.72) pg/ml in group 2 and (71.27 ± 17.86) pg/ml in group 3. Linear multivariate stepwise analysis showed that TK level was independently associated with coronary artery stenosis degree(P < 0.001) after adjusting for hypertension(P = 0.990),diabetes mellitus(P = 0.574) and smoking(P = 0.561). No association was found between VEGF level and obstruction grading. A threshold of 1 725 pg/ml provided the maximized predictive value of total obstruction. Conclusion:Plasma TK level was significantly higher in the presence of coronary artery disease. TK level was independently associated with coronary artery stenosis grading. TK measurement may be useful for the diagnosis of coronary artery stenosis grading.