急性心肌梗死患者氧化低密度脂蛋白抗体测定的临床意义

目的:探讨急性心肌梗死(AMI)患者血清氧化低密度脂蛋白抗体(anti-ox-LDL)的变化及临床意义。方法:68例AMI患者入院时根据临床情况分为静脉溶栓治疗组(Ⅰ亚组,46例)及非溶栓组(Ⅱ亚组,无溶栓适应证或存在禁忌证者22例),同时测定所有患者入院即刻及1个月后血清血脂及anti-ox-LDL水平,各组间进行比较并与对照组比较。结果:①AMI患者入院时血清anti-ox-LDL较对照组明显增高(P<0.01),1个月后显著降低(P<0.001)达对照组水平;②Ⅰ亚组、Ⅱ亚组患者入院时anti-ox-LDL差异无统计学意义;③Ⅰ亚组患者溶栓成功组(26例)与未成功组(20例)入院时anti-ox-LDL差异无统计学意义;④Ⅱ亚组患者急诊冠状动脉造影梗死相关动脉(IRA)末开通者(13例)入院时血清anti-ox-LDL明显高于IRA开通者(9例)。结论:anti-ox-LDL升高与冠状动脉硬化斑块的不稳定性有关,可能是AMI发作的一个危险因素,自发性血管再通可能与血清anti-ox-LDL降低有关,而溶栓所致血管再通则与此无关。     

急性ST段抬高型心肌梗死患者血清氧化低密度脂蛋白抗体IgM水平与冠状动脉病变程度的相关研究

目的探讨急性ST段抬高型心肌梗死(STEMI)患者血清氧化低密度脂蛋白抗体IgM(ox-LDL-Ab IgM)水平与冠状动脉病变程度的相关性。方法诊断明确并行急诊经皮冠状动脉介入治疗的STEMI患者95例,经冠状动脉造影检查明确诊断的不稳定型心绞痛(UAP)患者58例,冠状动脉造影正常患者38例为对照组。STEMI组根据冠状动脉造影结果分为单支病变组、双支病变组及三支病变组,并以Gensini积分评价冠状动脉狭窄程度,分别测定血清ox-LDL-Ab IgM水平,分析ox-LDL-Ab IgM水平与冠状动脉病变程度的关系。结果 UAP组、STEMI组的ox-LDL-Ab IgM水平均低于对照组(均为P<0.01),UAP组与STEMI组间差异无统计学意义(P=0.130);STEMI组血清ox-LDL-Ab IgM水平随冠状动脉病变支数增加而降低(P=0.000),但与Gensini积分未见相关性(P=0.212);ox-LDLAb IgM水平与丙二醛水平呈显著负相关性(r=-0.319,P=0.002)。结论血清ox-LDL-Ab IgM水平可在一定程度上反映STEMI患者冠状动脉病变的严重程度;它可能具有对抗动脉粥样硬化的作用。     

急性冠状动脉综合征患者血浆氧化型低密度脂蛋白及其抗体的临床意义

氧化型低密度脂蛋白(oxidized low density lipoprotein, ox-LDL)是动脉粥样硬化(a therosclerosis, As)的独立危险因子,其抗体(Anti-o x-LDL)在急性心肌梗死病人血浆中明显升高,且随病人血管再通而降低.自2002 年2月到2003年4月我们测定了急性冠状动脉综合征病人血浆中ox-LDL、Anti-ox -LDL变化,以探讨它们在As发生、发展中的作用及机制.……     

早期辛伐他汀干预对急性心肌梗死患者氧化型低密度脂蛋白的影响

目的观察早期他汀类药物干预对急性心肌梗死(AMI)早期血浆氧化低密度脂蛋白(oxLDL)的影响,以探讨AMI早期应用他汀类药物的必要性。方法所有入选患者均于干预前和治疗后5d抽取静脉血检测oxLDL、血脂等生化指标,分析辛伐他汀干预前后oxLDL的统计学意义。结果 20mg/d、40mg/d辛伐他汀组干预后oxLDL低于干预前(P<0.05),与对照组干预后比较,血浆oxLDL水平显著降低(P<0.05或P<0.01),40mg/d辛伐他汀组与20mg/d辛伐他汀组干预后oxLDL相比有统计学意义(P<0.05)。结论 ACS早期他汀类药物治疗具有抗oxLDL等调脂外效应,且存在剂量依赖性。     

ST段抬高急性心肌梗死患者血清氧化低密度脂蛋白抗体-IgM水平与冠状动脉病变程度及住院期间预后的相关研究

目的：探讨血清氧化低密度脂蛋白抗体-IgM（ox-LDL-Ab IgM）水平在ST段抬高急性心肌梗死（STEMI）患者中与冠状动脉病变程度及近期预后的相关性。方法选取2008年8月至2009年5月诊断明确并行急诊经皮冠状动脉介入（PCI）治疗的STEMI患者95例,根据冠状动脉造影结果分为单支病变组、双支病变组及三支病变组,并以Gensini积分评价冠状动脉狭窄程度,分别测定血清ox-LDL-Ab IgM、丙二醛（MDA）、血脂,计算体质量指数（BMI）,统计患者住院期间心血管事件发生情况,分析ox-LDL-Ab IgM水平与冠状动脉病变程度及近期预后的关系。结果 STEMI患者血清ox-LDL-Ab IgM水平随冠状动脉病变支数增加而降低（P＜0.05）,但与Gensini积分无明显相关性（P＞0.05）;ox-LDL-Ab IgM水平与血脂、血糖水平等无明显相关性（P＞0.05）,与MDA水平呈显著负相关（r＝-0.319,P＜0.05）;ox-LDL-Ab IgM水平与患者住院期间心血管事件发生率呈显著负相关（r＝-0.708,P＜0.05）,logistic回归分析显示, ox-LDL-Ab IgM是STEMI患者住院预后的保护因素（OR＝-0.588,P＜0.05）。结论血清ox-LDL-Ab IgM水平可在一定程度上反映STEMI患者冠状动脉病变的严重程度。其可能通过调节机体氧化应激水平,减少LDL氧化修饰生成ox-LDL,从而减轻冠状动脉粥样硬化的面积,可能对STEMI患者近期预后具有保护作用。     

急性缺血性脑血管病患者血清氧化型低密度脂蛋白抗体的检测

目的探讨氧化型低密度脂蛋白抗体检测在急性脑缺血发生发展过程中的作用及诊断价值。方法选择我院2007年6月~8月住院的急性脑缺血患者80例,根据发病时头颅磁共振检查结果,将患者分为急性脑梗死组与短暂脑缺血组,采用酶联免疫吸附法同时测定二组血清氧化型低密度脂蛋白抗体,检测血清生物化学各项指标,并对结果进行统计学分析。结果急性脑梗死组血清氧化型低密度脂蛋白抗体为38.07±32.14ku/L,短暂脑缺血组为25.18±9.17ku/L,二组比较有显著性差异(P<0.05);而与其它生物化学学指标无相关性。结论氧化型低密度脂蛋白抗体水平在不同类型脑缺血中有所不同,其升高有可能是急性脑梗死的危险信号。     

血浆氧化低密度脂蛋白测定的临床价值

目的 :观察脂代谢紊乱相关疾病患者血浆氧化低密度脂蛋白 (ox LDL)水平的变化规律 ,探讨血ox LDL测定的临床意义。方法 :素食 1d后禁食 12h采静脉血 ,用双抗体夹心ELISA法测定血浆ox LDL的水平。观察对象 30 2例 ,其中原发性高血压 (EH) 6 2例 ,EH并发冠心病 (CHD) 5 5例 ,糖尿病 (DM) 38例 ,DM并发CHD 4 9例 ,CHD 4 4例 ,肾病综合征 5 4例。正常对照者 111例。结果 :EH、DM、CHD、肾病综合征患者血ox LDL测定值均高于正常对照者 (P <0 .0 5 )。EH心室肥厚者ox LDL值明显高于非心室肥厚者 (P <0 .0 5 ) ;而并发CHD者明显高于未并发CHD者 (P <0 .0 5 )。DM并发CHD者明显高于未并发CHD者 (P <0 .0 5 ) ;但未并发CHD者血ox LDL仍高于正常对照者 ,差异有显著性意义 (P <0 .0 5 )。CHD中不稳定型心绞痛者明显高于稳定型心绞痛者 (P <0 .0 5 ) ;稳定型心绞痛者血ox LDL测定值与正常对照者差异无显著性意义 (P >0 .0 5 ) ;但冠状动脉 (冠脉 )显著狭窄者明显高于冠脉无显著狭窄者 (P <0 .0 5 ) ;冠脉无显著狭窄者血ox LDL测定值与正常对照者差异无显著性意义 (P >0 .0 5 )。结论 :EH及DM患者血ox LDL水平高于正常人 ,并发CHD后血ox LDL水平更高 ;CHD中不稳定型心绞痛患者血ox LDL水平高于正常人 ,ox LDL水平与冠     

氧化低密度脂蛋白抗体危险性的临床评估

大量研究已证实,免疫机制在动脉粥样硬化(AS)的进展过程中起着关键作用,体内低密度脂蛋白(LDL)发生氧化反应时形成氧化修饰的LDL,它可作为抗原表位而诱导机体发生特异性免疫反应形成氧化低密度脂蛋白(ox-LDL)抗体[1～3].     

氧化低密度脂蛋白的动脉粥样硬化

大量资料表明 ,血浆低密度脂蛋白 ( LDL )浓度升高是动脉粥样硬化 ( AS)的主要危险因素之一 ,但其机制尚未阐明。在某一特定的 LDL血浆浓度人群中 ,冠心病的发病和临床表现有很大差异。说明高脂血症与 AS的发生及冠心病的发病率和病死率之间存在复杂的多因素相互作用的机制。Steinbery等将氧化 LDL 与单核巨噬细胞( MM)的相互作用认为是粥样斑块 (脂纹 )中泡沫细胞形成的重要机制 ;而且 L DL的氧化修饰也可发生于人体 ,具有多种致 AS的细胞生物学效应 ,从而提出了动脉粥样硬化氧化修饰学说 ,具体如下。1　L DL氧化修饰过程及其理…     

氧化低密度脂蛋白及其自身抗体与冠心病的相关性

目的探讨氧化低密度脂蛋白(ox-LDL)及其自身抗体(ox-LDLAb)与冠心病(CHD)的相关关系,并绘制受试者工作特征曲线(ROC),评价其临床诊断意义。方法分别提取血浆和血清,用酶联免疫吸附(ELISA)方法测定血浆ox-LDL及血清ox-LDLAb浓度。结果冠心病患者ox-LDL、ox-LDLAb明显高于对照组(P<0.01),且急性心梗组(AMI)、不稳定心绞痛组(UAP)高于稳定心绞痛组(SAP)(P<0.05)。ox-LDL与ox-LDLAb)负相关。ROC曲线下面积ox-LDL为(0.805±0.039),0x-LD-LAb为(0.747±0.041),对急性冠脉综合征(ACS)有一定的鉴别力。结论血ox-LDL、ox-LDLAb水平的高低与冠心病严重程度呈正相关,可作为预测ACS和识别斑块不稳定的一项血清学指标。     

Clinical significance of the antibody against oxidized low-density lipoprotein in acute myocardial infarction

To establish the clinical significance of the antibody against oxidized low-density lipoprotein (anti-Ox-LDL) titer in patients with acute myocardial infarction (AMI), we measured the anti-Ox-LDL titer in 39 patients with AMI and 25 controls. In all AMI patients, the anti-Ox-LDL titer on admission was higher (p < 0.05) than the value in the controls. One month after admission, the titer decreased significantly (p < 0.001) reaching control levels. In patients who underwent thrombolytic therapy, the anti-Ox-LDL titer on admission was identical in patients with occluded infarct-related arteries (IRA) and patients with patent IRA during emergency coronary angiography. In patients who did not undergo thrombolytic therapy, the anti-Ox-LDL titer on admission was higher in patients with occluded IRA than in patients with patent IRA. An increased anti-Ox-LDL titer may be a risk factor for the onset of AMI. Spontaneous recanalization of the IRA may be associated with increased anti-Ox-LDL titers, while thrombolysis-induced recanalization may be independent of it.     

Relationship between low-density lipoprotein levels on admission and 1-year outcome in patients with acute ST-segment-elevation myocardial infarction

This study assessed the relationship between low-density lipoprotein cholesterol (LDL-C) levels on admission and the incidence of major adverse cardiovascular events (MACE) in patients with acute ST-segment-elevation myocardial infarction (ASTEMI). Patients with ASTEMI who had a lipid profile tested within 24 hours of symptom onset were enrolled. They were stratified into high and low LDL-C groups according to whether their LDL-C was above (n = 501) or below (n = 575) the median level, respectively. The incidence of MACE, cardiovascular death, non-fatal MI, revascularization, and stroke was compared between the groups at 1 month, 6 months, and 1 year. Survival analysis and Cox proportional hazard analysis were performed. In-hospital use of beta blockers was better in the high than in the low LDL-C group (76.6% vs. 69.7%, p = 0.01). Statin use was significantly higher in the high than in the low LDL-C group during follow-up (86.8% vs. 80.0%, p = 0.003 at1 month; 71.6% vs. 62.4%, p = 0.002 at 6 months; 67.8% vs. 61.2%, p = 0.03 at 1 year). The incidence of MACE on follow-up at 1 month was higher in the low than in the high LDL-C group (12.0% vs. 8.1%, p = 0.04). At 1 year, survival was not significantly different between the groups. Cox proportional hazards analysis indicated that the incidence of MACE was significantly associated with hypertension, current smoking, high-density lipoprotein cholesterol (HDL-C), in-hospital use of beta blockers, and statin use on follow-up (p < 0.01). LDL-C levels on admission in patients with ASTEMI had no significant effect on the 6-month and 1-year incidence of MACE, but the incidence of MACE was significantly higher in the low LDL-C group at 1 month. It would be relevant to further investigate the HDL-C level on admission, in-hospital use of beta blockers, and statin use during follow-up in relation to MACE.     

老年冠心病患者血中氧化修饰低密度脂蛋白抗体的表达

目的 :探讨低密度脂蛋白 （L DL ）氧化在老年动脉粥样硬化 （AS）形成中的作用。方法 :老年冠心病患者 6 5例（心绞痛患者 37例、心肌梗死患者 2 8例 ）和正常老年人 2 2例 ,检测其血清中氧化修饰低密度脂蛋白抗体 （OX-L DL - Ab）滴度。结果 :老年冠心病患者血清中 OX- L DL - Ab滴度显著高于正常对照组 （P<0 .0 1） ,其中心肌梗死组最高。结论 :老年冠心病患者体内低密度脂蛋白 （L DL ）氧化修饰增加 ,促进 AS的形成和发展。     

Antibodies to oxidized low-density lipoprotein in patients following coronary artery revascularization

BACKGROUND: Measurement of antibodies to oxidized low-density lipoprotein (AB-oxLDL) has been proposed as a way of identifying individuals at risk for cardiovascular disease beyond the determination of LDL cholesterol (LDL-c) alone. While this hypothesis is appealing, evidence that AB-oxLDL is a risk factor independent of LDL-c levels remains to be established. METHODS AND RESULTS: We conducted a cross-sectional study of 158 hypercholesterolemic adults who underwent coronary revascularization. Patients were randomized in a clinical trial to a nurse case management (NURS) or an enhanced usual care (EUC) group. The goal in the NURS group was to achieve an LDL-c <85 mg/dl with pharmacotherapy and lifestyle advice. Six months after revascularization, serum and urine were collected to determine lipids, AB-oxLDL, urinary isoprostanes (an in-vivo marker of oxidative damage), oxygen-radical-absorbing capacity (ORAC) of serum, serum carotenoids, alpha-tocopherol and C-reactive protein (CRP). After 6 months of intervention, the NURS group had a mean (+/-SD) LDL-c of 84 (18) mg/dl compared with 105 (25) mg/dl in the EUC group (P < 0.001). In addition, AB-oxLDL was lower (median +/- 95% confidence interval, -202 milliunits (mU)/ml, -372 to -32, P = 0.02) in the NURS group (488 mU/ml, 399, 588) than in the EUC group (690 mU/ml, 544, 847). The difference in AB-oxLDL between groups persisted after adjustment for LDL-c (-316 mU/ml, -519 to -112, P = 0.005). Further adjustment for ORAC and alpha-tocopherol did not diminish the group effect. The groups did not differ significantly in serum antioxidants, urinary isoprostane excretion or CRP. In additional analyses, change in LDL-c from baseline was not associated with AB-oxLDL at 6 months. CONCLUSIONS: Our results demonstrate lower AB-oxLDL in patients who achieve greater lipid reduction. However, AB-oxLDL appears to be independent of achieved LDL-c, ORAC levels or serum antioxidant levels. These results support the hypothesis that AB-oxLDL is independent of LDL-c level. Further prospective studies are needed to determine the prognostic value of AB-oxLDL.     

不同海拔地区汉族和藏族急性脑梗死患者血浆氧化低密度脂蛋白水平的研究

目的探讨不同海拔地区汉族和藏族急性脑梗死患者血浆氧化低密度脂蛋白(OX-LDL)水平的变化。方法前瞻性纳入不同海拔地区的急性脑梗死患者110例,其中汉族84例,藏族26例。84例汉族患者中,高海拔区(3800 m,果洛藏族自治州人民医院)26例,中海拔区(2200 m,青海省人民医院)30例,低海拔区(450 m,广汉市人民医院)28例。另选同地区年龄、性别基本匹配,世居当地的健康体检汉族人群为对照组,其中高海拔区26名,中海拔区25名,低海拔区28名。26例藏族脑梗死患者均来源于中海拔区(青海省人民医院);中海拔区健康对照组22名,高海拔区28名。采用双抗体夹心酶联免疫吸附法检测血浆OX-LDL水平。结果 (1)高、中、低海拔地区汉族脑梗死组血浆OX-LDL分别为(1.92±0.30)、(1.63±0.18)和(1.44±0.25)ng/L,均高于相应健康对照组的(1.45±0.54)、(1.34±0.32)、(1.19±0.24)ng/L,差异均有统计学意义(P﹤0.01)。(2)汉族脑梗死组及健康对照组的血浆OX-LDL含量均随着海拔高度的升高而升高,其中高、中、低海拔地区脑梗死组间比较,差异均有统计学意义(P﹤0.01或P﹤0.05);高、中海拔地区健康对照组的OX-LDL含量差异无统计学意义,但均高于低海拔地区(P﹤0.01)。(3)高、中海拔藏族健康人群血浆OX-LDL分别为(1.43±0.56)、(1.31±0.32)ng/L,差异无统计学意义。分别与同海拔的汉族健康对照组比较,差异亦均无统计学意义。(4)26例中海拔地区藏族脑梗死患者血浆OX-LDL为(1.91±0.40)ng/L,高于同海拔的健康对照组及汉族脑梗死组(P均﹤0.01)。结论随着海拔高度的增加,汉族脑梗死患者及其健康对照者血浆OX-LDL含量均升高;但脑梗死患者升高更显著。藏族脑梗死患者血浆OX-LDL水平高于同海拔的汉族脑梗死患者。