程序性细胞死亡因子4与氨基末端脑利钠肽前体在冠心病猝死者体内的表达及意义

刘笃秋 陈刚 吴旭庭 王镇波 庾宇军

[摘要]目的 研究冠心病猝死患者心肌组织中程序性细胞死亡因子4（PDCD4）的表达量与心血中氨基末端脑利钠肽前体（NTproBNP）的表达变化，探讨其在冠心病猝死者体内的表达及意义。方法 选取2015年7月～2018年6月于南方医科大学第五附属医院死亡并接受尸检的死亡病例60例，根据尸检结果分为冠心病猝死组（20例）、冠脉狭窄组（20例）以及冠脉正常组（20例），每个病例均收集心肌组织一块用于测定PDCD4的mRNA表达量及蛋白表达量，并抽取右心血样本采用酶联免疫吸附（ELISA）法检测血浆NTproBNP的水平。结果 冠心病猝死组心肌组织中PDCD4的mRNA表达量、蛋白表达量均高于另外两组，差异有统计学意义（P<0.05）；冠心病猝死组、冠脉狭窄组的血浆 NTproBNP含量均高于冠脉正常组，差异有统计学意义（P<0.05）；冠心病猝死组的血浆NTproBNP含量高于冠脉狭窄组，差异有统计学意义（P<0.05）。结论 PDCD4、NTproBNP的高表达与冠心病猝死的发生有关，能辅助判定冠心病的严重程度以及协助鉴定冠心病猝死。

[关键词]冠心病；心源性猝死；程序性细胞死亡因子 4；氨基末端脑利钠肽前体

[中图分类号] R541.4 [文献标识码] A [文章编号] 1674-4721（2018）12（c）-0004-05

[Abstract] Objective To analyse the expression of programmed cell death 4 （PDCD4） in myocardial tissues and Amimo-Terminal Pro-Brain Natriuretic Peptide （NTproBNP） in plasma of sudden death patients with coronary heart disease and to discuss its significance. Methods Totally 60 sudden death cases that underwent autopsy in the Fifth Affiliated Hospital of Southern Medical University from July 2015 to June 2018 were collected， and divided into sudden cardiac death with coronary heart disease group （20 cases）， single coronary stenosis group （20 cases） and normal control group （20 cases） according to the autopsy results. The myocardial tissue was collected to determine the mRNA expression of PDCD4 as well as the protein expression of PDCD4. NTproBNP in plasma were detected by ELISA. Results The mRNA expression and protein expression of PDCD4 in myocardial tissue of cardiac sudden death with coronary heart disease group were significantly higher than those in the other two groups， the differences were statistically significant （P<0.05）. NTproBNP in the sudden cardiac death with coronary heart disease group and single coronary stenosis group was higher than that normal control group， the difference was statistically significant （P<0.05）. NTproBNP in the sudden cardiac death with coronary heart disease group was higher than that in the single coronary stenosis group， the difference was statistically significant （P<0.05）. Conclusion These indicate that PDCD4 and NTproBNP have a certain guiding role in sudden cardiac death with coronary heart disease. PDCD4 and NTproBNP can help to identify the severity of coronary heart disease and whether it is sudden death due to coronary heart disease.

[Key words] Coronary heart disease； Sudden cardiac death； Programmed cell death 4； Amimo-Terminal Pro-Brain Natriuretic Peptide

冠状动脉粥样硬化性心脏病是由于冠状动脉发生了动脉粥样硬化病变，继而引起冠状动脉管腔狭窄或阻塞性改变，造成心肌缺血、缺氧，甚至坏死而导致的心脏疾病，简称冠心病。严重的冠心病能导致患者出现心肌梗死、恶性心律失常以及心力衰竭等，甚至会危及患者生命。冠心病分为五大類型，冠心病猝死是其中的一种分型，由于冠心病猝死的突然性以及不可预测性，给临床诊疗工作中产生极大困扰。程序性细胞死亡因子4（programmed cell death 4，PDCD4）是一种肿瘤抑制因子，而近年来有研究显示其不仅对细胞的程序性死亡起着重要的调节作用，而且与心血管细胞生物学也存在着非常密切的关系，并在动脉粥样硬化病变进展的过程中也起着重要的作用[1]。……