目的:探讨血清内脂素水平与冠心病病情进展程度的相关性和对ST段抬高性心肌梗死(STEMI)的诊断意义.方法:入选中日友好医院心脏科2016年1月～2017年1月间41例稳定性冠心病(SCAD)患者、196例STE-MI患者以及60例正常对照组患者,3组研究对象的外周动脉血清中内脂素表达水平的比较采用方差分析,内脂素与冠心病病情程度相关性采用Logistic回归分析,血清内脂素水平与STEMI诊断的相关性采用ROC曲线进行描述.结果:与正常对照组相比,SCAD组和STEMI组的血清内脂素水平均显著升高,且具有统计学意义(均P＜0.01).同时,STEMI组患者血清内脂素水平(9.1ng/ml)在3组中最高且具有统计学意义(P＜0.01).内脂素水平是冠心病患者发生STEMI的独立危险因素(OR:1.268,95％CI:1.138～1.413,P＜0.01),外周血清内脂素水平诊断冠心病患者发生STEMI的曲线下面积为0.766(95％CI:0.695～0.837,P＜0.01).结论:内脂素可以作为一项有意义的生物学标志物来反映冠心病的发生及病情程度.同时,外周血内脂素水平的升高可以作为STEMI发生的一个有效的诊断学指标.

Objective To investigate the potential factors influencing myocardial fibrosis (MF) in non-ischemic heart failure(HF) patients with an emphasis on the role of right heart catheter (RHC) parameters. Methods This retrospective research collected clinical data from 33 non-ischemic heart failure patients admitted to China-Japan Friendship Hospital who received endomyocardial biopsy (EMB) and right heart catheter (RHC) examination. All the patients were divided into two groups: mild MF (n=17) and severe MF (n=16), by means of K-means cluster analysis. MF was quantitatively evaluated by Masson staining. Potential factors influencing MF were analyzed. Results Compared with that in mild MF group, patients in severe MF group had aggravated cardiac function (cardiac index, 2.15±0.76 vs. 2.94±1.10,P＜0.05), accompanied by higher systolic right ventricle pressure (RVP), systolic pulmonary arterial pressure (PAP), pulmonary arterial wedge pressure (PAWP) and total pulmonary resistance (TPR) (P＜0.05). Hypertension and TPR were independently correlated with the degree of MF in multiple linear regression analysis (Adjusted R2=0.454, P＜0.001). Conclusions Hypertension and TPR, reflecting afterload of left and right ventricle, are found to be independently correlated with degree of MF in non-isch- emic heart failure patients. Cardiologists should pay more attention to high-risk patients in order to retard MF progression through timely intervention.