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目的:观察急性心肌梗死(AMI)患者围手术期血浆apelin的表达变化,分析AMI合并2型糖尿病(T2DM)患者血浆apelin的表达与预后的相关性,探讨apelin在冠脉介入治疗(PCI)中的心脏保护作用。方法:72例于2012年2月~8月在我院心内科接受冠状动脉造影确诊为AMI并成功完成PCI的冠心病患者,分别在术前、术后0小时、术后4小时、术后24小时收集血清,酶联免疫吸附法测定血浆apelin-13水平;进一步对糖尿病及非糖尿病AMI患者(每组各20例)进行亚组分析,随访两组患者在术后6个月时主要不良心脑血管事件(MACCE)。结果:AMI患者术后0 h组apelin水平与术前基线水平明显降低(31.54±5.48 vs35.15±6.48 ng/L,P<0.05);术后4小时及24小时组apelin水平较术前明显升高(39.65±5.48 vs 35.15±6.48 ng/L,43.93±5.37 vs35.15±6.48 ng/L,P<0.05)。糖尿病与非糖尿病组apelin水平术前无明显差异;糖尿病组在术后各时间点的apelin水平均明显高于非糖尿病组(31.12±5.50 vs 29.21±6.53 ng/L,40.57±5.37 vs 33.49±3.89 ng/L,43.50±7.41 vs 34.54±3.52 ng/L,P<0.05)。两组术后6个月随访T2DM组LVEF值改善明显高于NT2DM组,但MACCE事件无明显差异。结论:AMI患者PCI术后存在血浆apelin表达的升高,其中糖尿病患者在术后血浆apelin表达较非糖尿病患者明显增高,提示PCI冠脉血运重建可促进糖尿病患者apelin分泌,调节胰岛素抵抗改善预后。
Objective: To observe the changes of perioperative plasma apelin in patients with acute myocardial infarction (AMI) and to analyze the correlation between the expression of apelin and prognosis in patients with AMI and type 2 diabetes mellitus (T2DM) Heart protection. Methods: Seventy-two patients with coronary artery disease who underwent coronary angiography and coronary heart disease in our hospital from February to August 2012 were enrolled in the study. They were preoperatively, 0-hour, 4-hour, Serum apelin-13 levels were measured by enzyme-linked immunosorbent assay (ELISA). A subgroup analysis was performed on diabetic and non-diabetic patients with AMI (20 in each group). The follow-up of the two groups was mainly at 6 months after operation Cardiovascular and cerebrovascular events (MACCE). Results: The level of apelin in AMI patients was significantly lower than that before operation (31.54 ± 5.48 vs 35.15 ± 6.48 ng / L, P <0.05). The levels of apelin at 4 hours and 24 hours after operation were significantly higher than those before operation (39.65 ± 5.48 vs 35.15 ± 6.48 ng / L, 43.93 ± 5.37 vs35.15 ± 6.48 ng / L, P <0.05). There was no significant difference in apelin levels between diabetic and non-diabetic patients before surgery. The apelin levels of diabetic patients at each time point were significantly higher than those of non-diabetic patients (31.12 ± 5.50 vs 29.21 ± 6.53 ng / L, 40.57 ± 5.37 vs 33.49 ± 3.89 ng / L, 43.50 ± 7.41 vs 34.54 ± 3.52 ng / L, P <0.05). The improvement of LVEF in T2DM group was significantly higher than NT2DM group at 6 months after operation, but there was no significant difference in MACCE. Conclusions: There is an increase of plasma apelin expression after PCI in patients with AMI. The expression of apelin in diabetic patients after operation is significantly higher than that in non-diabetic patients, suggesting that coronary revascularization can promote apelin secretion in diabetic patients and regulate insulin resistance to improve prognosis .