血清超敏C反应蛋白、胱抑素C、白介素6—受体在急性冠脉综合征中的表达水平及临床价值

李飞星　易梦阳　谭俊辉　王晓元　王蕊　李方江

[摘要] 目的 通過检测冠心病患者外周血超敏C反应蛋白（hs-CRP）、胱抑素C（Cystatin C）和白介素6受体（IL-6R）的表达水平，探讨其对急性冠脉综合征早期识别的临床价值。 方法 连续选取2016年10月～2017年3月在河北北方学院附属第一医院心内科行冠状动脉造影术患者265例，根据患者病史、临床表现及冠状动脉造影结果分为急性心肌梗死（AMI）组89例、不稳定型心绞痛（UAP）组87例、稳定型心绞痛（SAP）组41例、冠状动脉无狭窄病变者为对照组48例。采用日立7070型全自动生化分析仪测定hs-CRP、Cystatin C水平，酶联免疫吸附测定（ELISA）技术检测外周血IL-6R水平。比较各组血清IL-6R、hs-CRP、Cystatin C表达水平。 结果 AMI组和UAP组血清hs-CRP、Cystatin C、IL-6R水平显著高于对照组，差异有统计学意义（P < 0.05）；AMI组和UAP组血清hs-CRP、Cystatin C、IL-6R水平高于SAP组，差异有统计学意义（P < 0.05）；AMI组血清IL-6R、hs-CRP水平高于UAP组，差异有统计学意义（P < 0.05），但两组间Cystatin C水平差异无统计学意义（P > 0.05）。 结论 hs-CRP、Cystatin C、IL-6R在AMI和UAP患者中的表达水平明显升高，提示其可能参与了AMI和UAP病理生理过程，因此临床检测hs-CRP、Cystatin C、IL-6R水平对急性冠脉综合征早期诊断有一定的参考价值。

[关键词] 急性冠脉综合征；超敏C反应蛋白；胱抑素C；白介素6受体

[中图分类号] R541 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0034-04

[Abstract] Objective To explore the clinical value of detecting the expressions of hypersensitive C-reactive protein （hs-CRP）， cystain C and interleukin 6-receptor （IL-6R） for early identification of acute coronary syndrome in coronary heart disease patients. Methods A total of 265 patients undergoing coronary arteriography in the Department of Cardiology of the First Affiliated Hospital of Hebei North University from October 2016 to March 2017 were consecutively selected. According to the patients′ history， clinical manifestations and coronary angiographic results， all the patients were divided into acute myocardial infarction （AMI） group （89 cases）， unstable angina pectoris （UAP） group （87 cases）， stable angina pectoris （SAP） group （41 cases） and 48 patients without coronary stenosis as control group. The serum levels of hs-CRP and Cystatin C levels were measured with Hitachi 7070 automatic biochemical analyzer， and the level of IL-6R in peripheral blood was detected by enzyme-linked immunosorbent assay （ELISA）. The expression levels of hs-CRP， Cystain C and IL-6R among the four groups were compared. Results The serum levels of hs-CRP， Cystatin C and IL-6R in the UAP group and AMI group were significantly higher than the control group （P < 0.05）.The serum levels of hs-CRP， Cystatin C and IL-6R in the AMI group and UAP group were significantly higher than the SAP group （P < 0.05）. The serum levels of IL-6R， hs-CRP in the AMI group were higher than the UAP group （P < 0.05）， but Cystatin C level had no difference between the two groups （P > 0.05）. Conclusion The expression levels of hs-CRP， Cystatin C and IL-6R are significantly higher in AMI and UAP patients， which promotes that the three inflammatory factors may be involved in the pathophysiological processes of AMI and UAP. Therefore， clinical detection of hs-CRP， Cystatin C， IL-6R levels have certain reference value for the early diagnosis of acute coronary syndrome.

[Key words] Acute coronary syndrome； Hypersensitive C-reactive protein； Cystain C； Interleukin 6- receptor

急性冠脉综合征（ACS）是炎性因子通过促进炎性细胞趋化浸润、局部氧化应激及斑块细胞外基质分解等途径参与易损斑块破裂、血栓形成的一组临床综合征[1]，包括急性心肌梗死（AMI）和不稳定型心绞痛（UAP）。糖尿病、高脂血症、高血压、肥胖、老年、吸烟作为ACS的传统危险因素，被普遍应用于冠心病诊断的危险分层[2]，然而上述危险因素不能反映ACS发生时的病理生理状态，而易损斑块的形成能够预测ACS发生发展。炎性反应不仅参与了心绞痛患者血管重构的过程[3]，而且还参与了斑块形成、发展和破裂的整个过程，所以在循环血中检测与易损斑块有关的炎性细胞因子成为了临床研究热点。……