李巧元,柳景华,吕昀,杜杰,赵东晖,汪国忠,李果,张英川

• 1:首都医科大学附属北京安贞医院心内科二十一病房
• 2:北京市心肺血管疾病研究所

摘要(Abstract)：

目的观察急性冠脉综合征(ACS)患者血浆成纤维细胞生长因子21(FGF21)的动态变化,分析其在ACS心肌缺血再灌注损伤中的作用,探讨其与患者近期预后是否有关。方法选取99例ACS患者行急诊经皮冠状动脉介入治疗(PCI)术前、术后即刻、术后72h血样,采用酶联免疫吸附法检测分析FGF21的动态变化,分析ACS患者术前、术后即刻、术后72h后的血浆FGF21浓度,并将ACS患者术前FGF21浓度与32例对照组的FGF21比较,研究两者的区别,探讨FGF21与再灌注治疗的关系,随访3个月观察患者近期预后。结果 ACS组患者术前FGF21浓度较对照组低,其值分别为(0.434±0.09)ng/ml和(0.616±0.07)ng/ml,ACS组患者术后即刻浓度较术前明显降低,其值分别为(0.254±0.076)ng/ml和(0.408±0.074)ng/ml,术后72h明显升高,其值分别为(0.887±0.039)ng/ml和(0.459±0.037)ng/ml。将ACS组按是否成功开通罪犯血管分为未处理组和再通组,分析发现未处理组较再通组术后即刻FGF21浓度高,术后72h的FGF21浓度低。随访3个月,发现冠状动脉病变数目多者预后差(RR=6.285,P<0.05),女性较男性预后差(RR=6.481,P<0.05)。结论心肌缺血损伤可导致血浆FGF21浓度降低,成功开通罪犯血管可使FGF21浓度明显升高,说明成功开通罪犯血管对FGF21浓度有影响,FGF21浓度变化与心肌缺血损伤存在相关性。随访观察发现,女性患者及三支病变患者主要负性心脏事件发生率较高,FGF21浓度变化对ACS患者3个月预后无明显影响。

关键词(KeyWords)： 成纤维细胞生长因子21;冠状动脉疾病;血管成形术,经腔,经皮冠状动脉;再灌注损伤

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81070227);; 2011年市教委科技计划及人文计划项目(KM201110025019);; 首都医科大学基础-临床科研合作基金(09JL47)

作者(Author): 李巧元,柳景华,吕昀,杜杰,赵东晖,汪国忠,李果,张英川

参考文献(References)：

• [1]Kharitonenkov A.FGFs and metabolism.Curr Opin Cardiol,2009,9:805-810.
• [2]Inagaki T,Dutchak P,Zhao G,et al.Endocrine regulation of the fasting response by PPAR alpha-mediated induction of fibroblast growth factor21.Cell Metab,2007,6:415-425.
• [3]Badman MK,Pission P,Kennedv AR,et al.Hepatic Fibroblast Growth Factor21is regulated by PPARalpha and is a key mediator of hepatic lipid metabolism in ketotic states.Cell Metab,2007,5:426-437.
• [4]Goffredo GG.A more meaning scoring system for determining the severity of coronary heart disease.Am J Cardiol,1983,51:606.
• [5]Tang EW,Wong CK,Herbison P,et al.Global Registry of Acute Coronary Events(GRACE)hospital discharge risk score accurately predicts long-term mortality post acute coronary syndrome.Am Heart J,2007,153:29-35.
• [6]Itoh N,Ornitz DM.Functional evolutionary history of the mouse FGF gene family.Dev Dyn,2008,237:18-27.
• [7]Mohammadi M,Olsen SK,Ibrahimi OA.Structural basis for fibroblast growth factor receptor activation.Cytokine Growth Factor Rev,2005,16:107-137.
• [8]Coskun T,Bina H A,Schneider M A,et al.Fibroblast growth factor21corrects obesity in mice.Endocrinology,2008,149:6018-6027.
• [9]Malkowski A,Sobolewski K,Jaworski S,et al.FGF binding by extracellular matrix components of Wharton's jelly.Acta Biochim Pol,2007,54:357-363.
• [10]Kharitonenkov A,Dunbar JD,Bina HA,et al.FGF21/FGF21receptor interaction and activation is determined by beta-Klotho.Cell Physiol,2008,215:1-7.
• [11]Amer P,Pettersson A,Mitchell PJ,et al.FGF21attenuates lipolysis in human adipocytes-A possible link to improved insulin sensitivity.FEBS Lett,2008,582:1725-1730.
• [12]Lv Y,Liu LJ,Zhang LK,et al.Fibroblast growth factor21as a possible endogenous factor inhibits apoptosis in cardiac endothelial cells.Chin Med J,2010,123:3417-3421.