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目的探讨早发冠心病患者外周血胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)、白细胞介素18(interleukin-18,IL-18)的表达及其意义。方法选取入住作者医院治疗的早发冠心病患者96例,依据睡眠呼吸暂停低通气指数(apnea-hypopnea index,AHI)将入选患者分为4组:早发冠心病组(n=18)、早发冠心病合并轻度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)组(n=25)、早发冠心病合并中度OSAHS组(n=28)、早发冠心病合并重度OSAHS组(n=25)。收集患者临床资料,所有患者均行冠状动脉造影检查,Gensini评分计算冠状动脉病变程度,酶联免疫吸附法检测外周血IGF-1、IL-18表达。结果各组外周血IGF-1、IL-18水平以及Gensini评分等比较,差异有统计学意义(P<0.05)。其中,早发冠心病合并重度OSAHS组外周血IGF-1水平较其它3组明显降低(P<0.05);早发冠心病合并重度OSAHS组较早发冠心病组、早发冠心病合并轻度OSAHS组外周血IL-18水平及Gensini评分明显升高(P<0.05)。与早发冠心病组、早发冠心病合并轻度OSAHS组相比,早发冠心病合并中度OSAHS组外周血IGF-1水平明显降低(P<0.05),IL-18水平及Gensini评分明显升高(P<0.05)。相关性分析结果显示:外周血浆IGF-1浓度与IL-18浓度呈明显负相关(r=-0.767,P<0.01),与Gensini评分呈正相关(r=0.782,P<0.01)。结论早发性冠心病并OSAHS患者外周血IGF-1降低,可能参与了OSAHS促早发冠心病的发生发展。
Objective To investigate the expression and significance of insulin-like growth factor-1 (IGF-1) and interleukin-18 (IL-18) in peripheral blood of patients with premature coronary heart disease. Methods Ninety-six patients with premature coronary artery disease admitted to our hospital were enrolled and divided into 4 groups according to apnea-hypopnea index (AHI): premature coronary heart disease (n = 18), early Coronary heart disease complicated with mild obstructive sleep apnea hypopnea syndrome (OSAHS) group (n = 25), premature coronary heart disease combined with moderate OSAHS group (n = 28), premature coronary heart disease Patients with severe OSAHS were enrolled (n = 25). The clinical data of patients were collected. All patients underwent coronary angiography, Gensini score of coronary artery disease, and the expression of IGF-1 and IL-18 in peripheral blood by enzyme-linked immunosorbent assay. Results The levels of IGF-1, IL-18 in peripheral blood and Gensini score in each group were significantly different (P <0.05). The levels of IGF-1 in peripheral blood in patients with premature coronary heart disease complicated with severe OSAHS were significantly lower than those in the other three groups (P <0.05). Premature coronary heart disease combined with severe OSAHS group had earlier onset of coronary heart disease and premature coronary heart disease with mild The level of IL-18 in peripheral blood and Gensini score in OSAHS group were significantly increased (P <0.05). The levels of IGF-1 in peripheral blood of patients with premature coronary heart disease and moderate OSAHS group were significantly lower than those of patients with premature coronary heart disease, premature coronary heart disease and mild OSAHS group (P <0.05), IL-18 level and Gensini score were significantly higher Increased (P <0.05). Correlation analysis showed that there was a negative correlation between plasma IGF-1 concentration and IL-18 concentration (r = -0.767, P <0.01), and positive correlation with Gensini score (r = 0.782, P <0.01). Conclusions IGF-1 in peripheral blood of patients with early-onset coronary heart disease and OSAHS is decreased, which may be involved in the occurrence and development of premature coronary artery disease in OSAHS.