高血压病人血清锌指蛋白A20、p53表达及与冠状动脉病变的关系.pdf

收稿日期 2022-04-13摇 修回日期 2022-11-15作者单位 秦皇岛军工医院 心内一科,河北 秦皇岛 066000作者简介 胡树凤(1979-),女,副主任医师.文章编号 1000鄄2200(2023)05鄄0614鄄04临床医学高血压病人血清锌指蛋白 A20、p53 表达及与冠状动脉病变的关系胡树凤,程方兵,王嘉伟,马摇 斌摘要目的:分析高血压病人血清锌指蛋白 A20、p53 表达及与冠状动脉病变的关系。方法:选取住院行冠状动脉造影检查的高血压病人 120 例,根据冠状动脉造影结果分为冠状动脉病变组(病变组)70 例和冠状动脉正常组(正常组)50 例。根据Gensini 评分,将病变组病人分为轻度组 40 例、中度组 20 例和重度组 10 例。采用酶联免疫吸附法检测各组血清 p53 表达水平,实时荧光定量 PCR 法检测血清锌指蛋白 A20 mRNA 表达,并分析二者相关性。采用 ROC 曲线分析血清锌指蛋白 A20mRNA、p53 表达水平对高血压病人发生冠状动脉病变的诊断效能。结果:病变组病人血清 A20 mRNA、p53 表达和低密度脂蛋白胆固醇水平均明显高于正常组(P 0.01)。病变组中,重度组病人 A20 mRNA 明显高于轻度组和中度组,中度组亦明显高于轻度组(P 0.01);重度组病人 p53 高于轻度组(P 0.05)。病变组血清 A20 mRNA 表达与 p53 表达水平呈正相关关系(r=0.702,P 0.05)。ROC 曲线分析结果显示,血清 A20 mRNA、p53 表达水平联合诊断高血压病人发生冠状动脉病变的曲线下面积为 0.799,敏感度76.80%,特异度为78.40%。结论:高血压合并冠状动脉病变病人血清锌指蛋白 A20 mRNA、p53 表达水平随冠状动脉病变的加重有逐渐升高趋势,且二者呈正相关关系,对诊断高血压病人发生冠状动脉病变具有一定临床价值。关键词 高血压;冠状动脉病变;血清锌指蛋白 A20;p53中图法分类号 R 544.1摇 摇 摇 文献标志码 A摇 摇 摇 DOI:10.13898/ki.issn.1000鄄2200.2023.05.014Expression of serum zinc finger protein A20 and p53in patients with hypertension and their relationship with coronary artery diseaseHU Shu鄄feng,CHENG Fang鄄bing,WANG Jia鄄wei,MA Bin(Department of Cardiology,Qinhuangdao Jungong Hospital,Qinhuangdao Hebei 066000,China)Abstract Objective:To analyze the expression of serum zinc finger protein A20 and p53 in patients with hypertension and theirrelationship with coronary artery disease.Methods:One hundred and twenty patients with hypertension who were hospitalized andunderwent coronary angiography were selected.According to the results of coronary angiography,they were divided into coronary arterydisease group(disease group,70 cases)and normal coronary artery group(normal group,50 cases).According to the Gensini score,patients in the disease group were divided into mild group(40 cases),moderate group(20 cases)and severe group(10 cases).Enzyme鄄linked immunosorbent assay method was used to detect serum p53 level,real鄄time fluorescent quantitative PCR method wasused to detect serum zinc finger protein A20 mRNA level,and the correlation between the two was analyzed.ROC curve was used toanalyze the diagnostic efficacy of serum zinc finger protein A20 mRNA and p53 levels for coronary artery disease in patients withhypertension.Results:Compared with the normal group,the serum zinc finger protein A20 mRNA,p53 and low鄄density lipoproteincholesterol levels in the disease group were significantly increased(P 0.01).The levels of serum zinc finger protein A20 mRNA andp53 in patients with severe coronary artery disease were significantly higher than those in the mild group and moderate group,and themoderate group were higher than the mild group,the difference was statistically significant(P 0.05 to P 0.01).The level of serumzinc finger protein A20 mRNA in patients with coronary artery disease was positively correlated with the level of p53(r=0.702,P 0.05).ROC curve analysis results showed that the area under the curve of combined diagnosis for coronary artery disease inhypertensive patients was 0.799,with a sensitivity of 76.80%,and a specificity of 78.40%.Conclusions:Serum zinc finger proteinA20 mRNA and p53 levels in patients with hypertension and coronary artery disease gradually increase with the severity of coronaryartery disease,and there is a positive correlation between the two,which has certain value in the diagnosis of coronary artery disease inhypertensive patients.Key words hypertension;coronary artery disease;serum zinc finger protein A20;p53摇 摇 高血压是心脑血管疾病的危险因素,与冠心病关系密切1。我国高血压合并冠心病的发病率及死亡率日趋上升,目前冠心病确诊主要依靠冠状动416J Bengbu Med Coll,May 2023,Vol.48,No.5脉造影,但其设备要求高,操作有一定难度2。而冠心病病人动脉粥样硬化的主要原因是由于氧化型低密度脂蛋白升高,导致动脉血管内皮细胞和平滑肌细胞受损,从而释放大量炎性因子,导致血管内皮发生慢性炎症反应3。锌指蛋白 A20 作为内源性调节蛋白,参与机体炎症反应,可能影响冠状动脉粥样硬化斑块的发生和发展4。p53 为凋亡相关因子,有抑制癌细胞生长的作用,中晚期肝癌病人血清p53 水平显著降低,同时其具有调节脂质作用5。本研究探讨高血压病人血清锌指蛋白 A20、p53 表达与冠状动脉病变的关系,以期为高血压合并冠心病病人的诊断和治疗提供参考。现作报道。1摇 资料与方法1.1摇 一般资料摇选取 2020 年 1 月至 2021 年 1 月于我院心内科住院并行冠状动脉造影检查的高血压病人 120 例,其中男 71 例,女 49 例,年龄 45 69岁。根据冠状动脉造影结果6,任一冠状动脉管径狭窄逸50%者作为冠状动脉病变,将病人分为冠状动脉病变组(病变组)70 例和冠状动脉正常组(正常组)50 例。收集病人一般资料,包括年龄、性别、血压、心率、体质量指数(BMI)、吸烟史、高血压病程等。纳入标准:(1)符合高血压诊断标准;(2)可进行冠状动脉造影;(3)知情同意自愿参与。排除标准:(1)合并肝肾功能不全;(2)严重创伤、手术及重症感染;(3)合并恶性肿瘤;(4)资料不全。根据Gensini 评分7,将病变组分为轻度组 40 例(Gensini评分 40 分)。本研究经过医院伦理委员会审批同意(伦理批准号:20191209)。1.2摇 方法摇1.2.1摇生化指标检测摇 2 组病人均于入院时采集清晨空腹静脉血 5 mL,采用全自动生化检测仪测定血糖(Glu)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、低密度脂蛋白胆固醇(low鄄density lipoprotein cholesterol,LDL鄄C)、高密度脂蛋白胆固醇(high鄄density lipoprotein cholesterol,HDL鄄C)、血尿酸(uric acid,UA)、丙氨酸氨基转移酶(alanine amiotransferase,ALT)、天冬氨酸氨基转移酶(aspartate amiotransferase,AST)等生化指标。1.2.2摇 血清锌指蛋白 A20 mRNA 检测摇 采用实时荧光定量 PCR(qRT鄄PCR)法检测血清锌指蛋白 A20mRNA 表达。用 EDTA鄄2K 抗凝管采集病人动脉血4 mL,Ficoll 密度梯度离心法分离外周血淋巴细胞,提取总 RNA,反转录合成 cDNA 后,进行 qRT鄄PCR反应。反应条件:97 益预变性 30 s,然后 96 益变性10 s,54 益退火 30 s,70 益延伸 30 s,共 41 个循环。血清锌指蛋白 A20 mRNA 及内参基因 茁鄄actin 引物由上海生工生物有限公司合成,引物序列见表 1。表 1摇 qRT鄄PCR 引物序列基因名称正向引物5忆鄄3忆反向引物5忆鄄3忆A20GGA AGC TTG TGG CGC TGA ATCC AGT TCC CAG CGA ATT TA茁鄄actinCAC GAA ACT ACC TTC AAC TCCCAT ACT CCT GCT TGC TGA TC1.2.3摇 血清 p53 蛋白水平检测摇使用 ELISA 法