Relationship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure.
Relationship between free fatty acids, insulin resistance markers, and oxidized lipoproteins in myocardial infarction and acute left ventricular failure.
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DOI：
10.2147/dmso.s37830
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Barbarash O
中科院分区：
文献类型：
--
作者：
Gruzdeva O;Uchasova E;Dyleva Y;Belik E;Kashtalap V;Barbarash O
心肌梗死(MI)最常见的原因是心外膜下冠状动脉狭窄的动脉粥样硬化病变。动脉疾病进展会引起临床症状和体征，其中心肌梗死是死亡率和发病率最高的疾病。最近的研究一直在努力寻找能够预测临床并发症演变的新的生化标志物，其中，游离脂肪酸(FFA)和低密度脂蛋白的氧化修饰(氧化低密度脂蛋白)具有特殊的地位。79例ST段抬高型心肌梗死患者入选。第一组包括没有急性心力衰竭(Killip分级I级)体征的MI患者，而第二组为Killip分级II-IV级的MI患者。33名无心血管疾病的受试者为对照组。分别于第1、12天测定血脂、血清氧化低密度脂蛋白及其抗体、C-肽和胰岛素水平，并用定量胰岛素敏感性检查指数(Quicki)评价胰岛素抵抗程度。MI患者有动脉粥样硬化性血脂异常；然而，Killip II-IV组的FFA、氧化型低密度脂蛋白及其抗体的增加最显著且持续时间最长。此外，两组的游离脂肪酸水平与肌酸激酶活性呈正相关(12天，R=0.301；P=0.001)，Quicki指数与游离脂肪酸水平呈负相关(R=−0.46；P=0.0013；R=−0.5；P=0.0013)。心肌梗死并发症的发生伴随着FFA水平的显著升高，FFA不仅表现为心肌损伤，而且参与了胰岛素抵抗的发生发展。测定FFA水平对急性和复发冠状动脉事件的风险分层和治疗策略的选择具有很大的预测潜力。
The most common cause of myocardial infarction (MI) is stenotic atherosclerotic lesions in subepicardial coronary arteries. Artery disease progression induces clinical signs and symptoms, among which MI is the leader in mortality and morbidity. Recent studies have been trying to find new biochemical markers that could predict the evolution of clinical complications; among those markers, free fatty acids (FFA) and oxidative modification of low-density lipoproteins (oxidized LDL) have a special place. Seventy-nine ST-elevation MI patients were enrolled. The first group included MI patients without the signs of acute heart failure (Killip class I) while MI patients with Killip classes II–IV made up the second group. Thirty-three individuals with no cardiovascular disease were the controls. The lipid profile, serum oxidized LDL, and their antibodies, C-peptide and insulin were measured at days 1 and 12. The level of insulin resistance was assessed with the quantitative insulin sensitivity check index (QUICKI). MI patients had atherogenic dyslipidemia; however, the Killip II–IV group had the most pronounced and prolonged increase in FFA, oxidized LDL, and their antibodies. Additionally, positive correlations between FFA levels and creatine kinase activity (12 days, R = 0.301; P = 0.001) and negative correlations between the QUICKI index and FFA levels (R = −0.46; P = 0.0013 and R = −0.5; P = 0.01) were observed in the both groups. The development of MI complications is accompanied by a significant increase in FFA levels, which not only demonstrate myocardial injury, but also take part in development of insulin resistance. Measuring FFA levels can have a great prognostic potential for risk stratification of both acute and recurrent coronary events and choice of treatment strategy.