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目的:探究外周血白细胞端粒长度(LTL)与早发冠心病的相关性及其影响因素。方法:纳入早发冠心病患者128例(早发冠心病组,其中急性冠状动脉综合征患者88例,稳定性冠心病患者40例),非冠心病患者128例(非冠心病组),两组≤30岁、31~40岁、41~50岁、51~60岁年龄段患者均为2、14、65、47例。采用荧光定量方法测定外周血LTL,采用Spearman相关及多元线性回归,分析LTL与早发冠心病的相关性及其影响因素。结果:早发冠心病组中急性冠状动脉综合征患者的男性比例、Gensini评分较稳定性冠心病患者高,端粒与单拷贝基因比率(T/S比率)、LTL较稳定性冠心病患者低,差异有统计学意义(P均<0.05)。早发冠心病组外周血T/S比率较非冠心病组显著降低(0.88±0.86 vs 1.10±0.57,P<0.05),但两组10年T/S比率变化值差异无统计学意义(-0.17±0.10vs-0.25±0.07,P=0.63)。早发冠心病组及和非冠心病组T/S比率均与年龄呈负相关(r=-0.275,P=0.002;r=-0.316,P=0.000)。Spearman相关分析显示,早发冠心病组患者LTL与高脂血症(r=-0.415,P=0.049)、糖尿病(r=-0.472,P=0.036)均呈明显负相关。多元线性回归分析显示,早发冠心病组LTL与年龄呈负相关(B=-0.023,P=0.038);非冠心病组LTL与年龄(B=-0.027,P=0.000)、吸烟史(B=-0.278,P=0.012)、高密度脂蛋白胆固醇(B=-0.297,P=0.046)水平均呈负相关。结论:在早发冠心病患者中,急性冠状动脉综合征患者男性更多见、LTL更短、冠状动脉病变更加严重。与非冠心病组比较,早发冠心病患者的外周血LTL明显缩短但缩短速率并未增加。早发冠心病患者LTL与高脂血症、糖尿病明显负相关,年龄的增长是导致其端粒缩短的最主要因素;而对于非冠心病患者,除了年龄增长外,吸烟、高密度脂蛋白胆固醇水平改变也是引起端粒缩短加速的主要因素。
Objective: To investigate the correlation between peripheral blood leukocyte telomere length (LTL) and premature coronary heart disease and its influencing factors. Methods: 128 patients with premature coronary heart disease (premature coronary heart disease group, 88 patients with acute coronary syndrome, 40 patients with stable coronary heart disease), 128 non-coronary heart disease patients (non-coronary heart disease group), two Group ≤ 30 years old, 31 to 40 years old, 41 to 50 years old, 51 to 60 years old patients were 2,14,65,47 cases. Peripheral blood LTL was measured by fluorescence quantitative method, and Spearman correlation and multiple linear regression were used to analyze the correlation between LTL and premature coronary heart disease and its influencing factors. Results: The proportion of male patients with acute coronary syndrome in the group of premature coronary heart disease, Gensini score was higher than that in patients with stable coronary heart disease, the ratio of telomere to single copy gene (T / S ratio), LTL was lower than that of patients with stable coronary heart disease , The difference was statistically significant (P <0.05). The T / S ratio of peripheral blood in patients with premature coronary heart disease was significantly lower than that of non-coronary heart disease patients (0.88 ± 0.86 vs 1.10 ± 0.57, P <0.05), but there was no significant difference in the 10-year T / 0.17 ± 0.10 vs.-0.25 ± 0.07, P = 0.63). The T / S ratio in patients with premature coronary heart disease and non-coronary heart disease was negatively correlated with age (r = -0.275, P = 0.002; r = -0.316, P = 0.000). Spearman correlation analysis showed that there was a significant negative correlation between LTL and hyperlipidemia (r = -0.415, P = 0.049) and diabetes (r = -0.472, P = 0.036) in patients with premature coronary heart disease. Multivariate linear regression analysis showed that the LTL in patients with premature coronary heart disease was negatively correlated with age (B = -0.023, P = 0.038). The LTL was positively correlated with age (B = -0.027, P = 0.000) = -0.278, P = 0.012), and high density lipoprotein cholesterol (B = -0.297, P = 0.046). CONCLUSIONS: Among the patients with premature coronary artery disease, more men are found in patients with acute coronary syndromes, with shorter LTL and more severe coronary artery disease. Compared with non-coronary heart disease group, the LTL of peripheral blood in patients with premature coronary heart disease was significantly shortened but the rate of shortening did not increase. In patients with premature coronary heart disease, LTL was significantly negatively correlated with hyperlipidemia and diabetes, and age was the most important factor leading to telomere shortening. For non-CHD patients, in addition to age, smoking, high density lipoprotein cholesterol Horizontal changes are also the major contributors to telomere shortening.