非对称性二甲基精氨酸和胱氨酸蛋白酶抑制剂C与冠心病

目的 探讨冠状动脉疾病中血浆非对称性二甲基精氨酸(ADMA)与胱氨酸蛋白酶抑制剂C(Cystatin C)之间的关系.方法 选取冠心病患者87例(其中急性心肌梗死39例,不稳定性心绞痛48例),健康对照组51例;同时,依据Cystatin C水平将冠心病患者分为Cystatin C升高组(51例)与无Cystatin C升高组(36例),采用高效液相色谱法测定血浆中ADMA、对称性二甲基精氨酸(SDMA)、左旋精氨酸(L-Arg)的含量,采用德国BNProSpec全自动速率散色比浊仪测定血浆Cystatin C的含量.结果 冠心病患者血浆ADMA(0.47±0.15)μmol/L比(0.37±0.15)μmol/L]、SDMA(0.39±0.19)μmol/L比(0.28±0.12)μmol/L]和Cystatin C浓度(1.16±0.32)mg/L比(0.73±0.16)mg/L]均高于正常对照组(P均<0.05),L-Arg浓度低于正常对照组(59.4±19.4)μmol/L比(83.7±19.6)μmol/L,P<0.05];对冠心病组的亚组分析显示血浆ADMA、L-Arg和Cystatin C浓度在心肌梗死组较心绞痛组差异无统计学意义.在Cystatin C<1 mg/L的冠心病患者中血浆ADMA与正常对照组比较,差异无统计学意义;而在Cystatin C>1 mg/L的冠心病患者血浆ADMA高于正常对照组(0.50±0.17)μmol/L比(0.39±0.15)μmol/L,P<0.05].结论 只有在血浆Cystatin C水平升高的冠心病患者血浆ADMA水平才明显升高,提示冠心病患者血浆ADMA水平的升高并不与冠心病直接相关,可能与冠心病患者伴随轻微肾损害有关.

Plasma asymmetric dimethylarginine and cystatin C levels in patients with coronary artery disease

Objective To compare plasma asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and cystatin C levels in patients with or without coronary artery disease (CAD). Methods We recruited 87 CAD patients (39 with acute myocardial infarction and 48 with unstable angina pectoris ) and 51 non-CAD controls. Plasma ADMA was measured by HPLC, cystatin C by particleenhanced immunonephelometric assay (N Latex cystatin C, Dade Behring) with anephelometer (BNII, Dade Behring). CAD patients were further divided into low cystatin C group ( < 1.0 mg/L, 36 cases) and high cystatin C group ( > 1.0 mg/L, 51 cases). Results ( 1 ) The plasma levels of ADMA (0. 47 ± 0. 15 )μmol/L vs. (0. 37 ±0. 15) μmol/L], SDMA (0. 39 ±0. 19) μmol/L vs. (0. 28 ±0. 12) μmol/L] and cystatin C (1.16 ±0. 32)mg/L vs. (0. 73 ±0. 16)mg/L] were significantly higher in CAD patients than in controls (all P < 0. 05 ). The plasma L-Arg was significantly lower in CAD patients than in controls (59.4 ± 19.4) μmol/L vs. (83. 7 ± 19. 6) μmol/L, P <0. 05]. (2) Plasma ADMA was similar in CAD patients with low cystatin C level and controls (0. 42 ±0. 12) μmol/L vs. (0. 39 ±0. 15) μ mol/L, P =0. 251] and Plasma ADMA was significantly higher in CAD patients with high cystatin C level than in controls (0. 50 ±0. 17) μmol/L vs. (0. 39 ±0. 15) μmol/L, P <0. 05]. Conclusion ADMA levels were significantly increased only in CAD patients with elevated cystatin C levels but not in CAD patients with normal renal function. The reported relationship between coronary heart disease and ADMA may not be direct, but could be secondary due to reduced renal function.