| 51 | 0 | 82 |
| 下载次数 | 被引频次 | 阅读次数 |
为探讨巨细胞病毒（CMV）与冠状动脉损伤的关系及对老年冠心病患者预后的影响，本研究选取2018年12月-2022年12月我院收治的老年冠心病合并CMV感染患者152例，检测患者血浆CMV-DNA载量，根据患者CMV载量分为高CMV组（72例）和低CMV组（80例）。所有患者随访2年，每3月随访1次，根据是否发生不良事件将患者分为预后良好组（88例）和预后不良组（64例）。检测患者血清细胞间黏附分子-1(ICAM-1)、半胱天冬酶-3(caspase-3)、肿瘤坏死因子α(TNF-α)、内皮素-1(ET-1)水平。采用Spearman分析进行相关性评估。采用COX回归分析老年冠心病患者预后不良的危险因素。采用受试者工作（ROC）曲线分析CMV载量、血清ICAM-1、caspase-3、TNF-α、ET-1水平预测老年冠心病患者预后不良的价值。结果显示，高CMV组血清ICAM-1、caspase-3、TNF-α、ET-1水平高于低CMV组（P<0.05）。CMV载量与老年冠心病患者血清ICAM-1、caspase-3、TNF-α、ET-1水平呈正相关（P<0.05）。预后不良组血清ICAM-1、caspase-3、TNF-α、ET-1水平、CMV高载量患者比例高于预后良好组（P<0.05）。老年冠心病患者预后不良与CMV载量、血清ICAM-1、caspase-3、TNF-α、ET-1水平呈正相关（P<0.05）。CMV载量、血清ICAM-1、caspase-3、TNF-α、ET-1水平是老年冠心病患者预后不良的危险因素（P<0.05）。CMV载量、血清ICAM-1、caspase-3、TNF-α、ET-1水平、五种指标联合预测老年冠心病患者预后不良的曲线下面积（AUC）分别为0.712、0.750、0.702、0.783、0.750、0.932，约登指数分别为0.423、0.371、0.331、0.519、0.439、0.702。以上结果表明，CMV载量与老年冠心病患者冠状动脉损伤指标血清ICAM-1、caspase-3、TNF-α、ET-1水平相关，是老年冠心病患者预后的影响因素，CMV载量联合血清ICAM-1、caspase-3、TNF-α、ET-1水平可辅助评估患者预后情况。
Abstract：This study aimed to investigate the association between cytomegalovirus(CMV) infection and coronary artery injury, as well as its impact on the prognosis of elderly patients with coronary heart disease(CHD). A total of 152 elderly CHD patients with confirmed CMV infection admitted to our hospital between December 2018 and December 2022 were enrolled. Plasma CMV-DNA load was measured, and patients were categorized into a high-CMV-load group(n = 72) and a low-CMV-load group(n = 80). All patients were followed up for two years at three-month intervals. Based on the occurrence of adverse events, patients were further classified into a good prognosis group(n = 88) and a poor prognosis group(n = 64). Serum levels of intercellular adhesion molecule-1(ICAM-1), caspase-3, tumor necrosis factor-α(TNF-α), and endothelin-1(ET-1) were assessed. Spearman correlation analysis was used to evaluate the associations between CMV load and these serum markers, as well as their relationship with disease prognosis. COX regression analysis was performed to identify risk factors for poor prognosis. Receiver operating characteristic(ROC) curves were used to evaluate the predictive value of CMV load and serum ICAM-1, caspase-3, TNF-α, and ET-1 levels. The results showed that serum levels of ICAM-1, caspase-3, TNF-α, and ET-1 were significantly higher in the high-CMV-load group compared to the low-load group(P < 0.05). CMV load was positively correlated with serum ICAM-1, caspase-3, TNF-α, and ET-1 levels(P < 0.05). Patients in the poor prognosis group exhibited higher levels of these markers and a greater proportion of high CMV load than those in the good prognosis group(P < 0.05). Poor prognosis was positively associated with CMV load and elevated serum levels of ICAM-1, caspase-3, TNF-α, and ET-1(P < 0.05). These variables were identified as independent risk factors for adverse outcomes. The area under the ROC curve(AUC) for predicting poor prognosis using CMV load, ICAM-1, caspase-3, TNF-α, and ET-1 levels individually were 0.712, 0.750, 0.702, 0.783, and 0.750, respectively, while the combined model yielded an AUC of 0.932. Corresponding Youden indices were 0.423, 0.371, 0.331, 0.519, 0.439, and 0.702, respectively. In conclusion, CMV load is significantly associated with coronary artery injury biomarkers in elderly CHD patients and is an independent prognostic factor. The combination of CMV load and serum levels of ICAM-1, caspase-3, TNF-α, and ET-1 may serve as valuable indicators for prognostic assessment in this population.
[1]骆剑蛟，刘亚茹，陈文.芍药苷对巨细胞病毒感染小鼠脑组织损伤及海马神经元细胞凋亡的影响[J].病毒学报，2021, 37(4):790-797. DOI:10. 13242/j. cnki.bingduxuebao. 003946.
[2]Arnouts L, Van Mechelen K, Laroche S, et al. Nonprimary CMV infection not always innocent. A casereport and literature review[J]. Acta Clin Belg, 2022,77(1):96-100. DOI:10. 1080/17843286. 2020. 1773651.
[3]Jena A, Mishra S, Singh AK, et al. Cytomegalovirus in ulcerative colitis:an evidence-based approach to diagnosis and treatment[J]. Expert Rev Gastroenterol Hepatol, 2022, 16(2):109-120. DOI:10. 1080/17474124. 2022. 2032662.
[4]Shaya GE, Leucker TM, Jones SR, et al. Coronary heart disease risk:Low-density lipoprotein and beyond[J]. Trends Cardiovasc Med, 2022, 32(4):181-194.DOI:10. 1016/j. tcm. 2021. 04. 002.
[5]Simonetto C, Rospleszcz S, Kaiser JC, et al.Heterogeneity in coronary heart disease risk[J]. Sci Rep, 2022, 12(1):10131. DOI:10. 1038/s41598-022-14013-3.
[6]李玲，梁霄，杨茂，等.巨细胞病毒感染通过p38MAPK途径对冠状动脉内皮细胞的损伤作用[J].病毒学报，2024, 40(1):58-64. DOI:10. 13242/j.cnki. bingduxuebao. 004457.
[7]中华医学会心血管病学分会介入心脏病学组，中华医学会心血管病学分会动脉粥样硬化与冠心病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，等.稳定性冠心病诊断与治疗指南[J].中华心血管病杂志，2018, 46(9):680-694. DOI:10. 3760/cma. j. issn. 0253-3758. 2018. 09. 004.
[8]Alpert JS. New coronary heart disease risk factors[J].Am J Med, 2023, 136(4):331-332. DOI:10. 1016/j.amjmed. 2022. 08. 002.
[9]Fan J, Watanabe T. Atherosclerosis:known and unknown[J]. Pathol Int, 2022, 72(3):151-160. DOI:10. 1111/pin. 13202.
[10]Francis T, Delk A, Gammon RR. CMV screening of group-specific orders-good stewardship of the blood supply[J]. Transfusion, 2022, 62(1):151-156. DOI:10. 1111/trf. 16742.
[11]Munks MW, Rott K, Nesterenko PA, et al. Latent CMV infection of Lymphatic endothelial cells is sufficient to drive CD8 T cell memory inflation[J].PLoS Pathog, 2023, 19(1):e1010351. DOI:10. 1371/journal. ppat. 1010351.
[12]Solary E. Macrophage colony-stimulating factor as a weapon against cytomegalovirus[J]. EMBO Mol Med,2023, 15(11):e18319. DOI:10. 15252/emmm. 202318319.
[13]Aguiar A, Galinato M, Bradley Silva M, et al. Human cytomegalovirus replication and infection-induced syncytia formation in labial, foreskin, and fetal lung fibroblasts[J]. Viruses, 2021, 13(12):2355. DOI:10. 3390/v13122355.
[14]Singh V, Kaur R, Kumari P, et al. ICAM-1 and VCAM-1:gatekeepers in various inflammatory and cardiovascular disorders[J]. Clin Chim Acta, 2023,548:117487. DOI:10. 1016/j. cca. 2023. 117487.
[15]Asadi M, Taghizadeh S, Kaviani E, et al. Caspase-3:Structure, function, and biotechnological aspects[J].Biotechnol Appl Biochem, 2022, 69(4):1633-1645.DOI:10. 1002/bab. 2233.
[16]Xu J, Jiang X, Xu S. Aprocitentan, a dual endothelin-1(ET-1)antagonist for treating resistant hypertension:Mechanism of action and therapeutic potential[J]. Drug Discov Today, 2023, 28(11):103788. DOI:10. 1016/j. drudis. 2023. 103788.
[17]Moshomo T, Molefe-Baikai OJ, Bennett K, et al.Cytomegalovirus immunoglobulin G levels and subclinical arterial disease among people living with HIV in Botswana:a cross-sectional study[J]. Biomedicines,2024, 12(5):935. DOI:10. 3390/biomedicines12050935.
[18]Mandal P, Louise McCormick A, Mocarski ES. TNF signaling dictates myeloid and non-myeloid cell crosstalk to execute MCMV-induced extrinsic apoptosis[J].Viruses, 2020, 12(11):1221. DOI:10. 3390/v12111221.
[19]Boeira MCDR, Dorneles GP, Junior WF, et al. The influence of physical activity level and cytomegalovirus serostatus on the cytokine levels of young individuals[J]. Immunol Lett, 2023, 256-257:28-33. DOI:10. 1016/j. imlet. 2023. 03. 006.
[20]Zhou W, Xi D, Shi Y, et al. microRNA-1929-3p participates in murine cytomegalovirus-induced hypertensive vascular remodeling through Ednra/NLRP3 inflammasome activation[J]. Int J Mol Med,2021, 47(2):719-731. DOI:10. 3892/ijmm. 2020. 4829.
[21]Dadashi M, Hajikhani B, Ghazi M, et al. The global prevalence of Chlamydia pneumoniae, Helicobacter pylori, Cytomegalovirus and Herpes simplex virus in patients with coronary artery disease:a systematic review and meta-analysis[J]. Microb Pathog, 2021,152:104572. DOI:10. 1016/j. micpath. 2020. 104572.
[22]梁秀琴，李便荣，史小峰，等.老年冠心病并发巨细胞病毒感染与血液流变学和内皮素水平及预后的关系[J].中华医院感染学杂志，2022, 32(17):2579-2582.DOI:10. 11816/cn. ni. 2022-211954.
[23]强玉娜，吕树志，邢祝乔，等.巨细胞病毒感染与冠心病重症患者血液流变学和内毒素水平及预后的关系[J].中华医院感染学杂志，2022, 32(23):3562-3566.
[24]吴忠林，谢力民. RBP4、ICAM-1与冠心病患者PCI术预后的相关性[J].中国实验诊断学，2022, 26(9):1311-1315. DOI:10. 3969/j. issn. 1007-4287. 2022. 09. 013.
[25]赵元平，于恺，薛莹，等.血清Caspase-3在急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗前后水平变化及其与再灌注损伤关系[J].临床军医杂志，2023, 51(11):1117-1120, 1124. DOI:10. 16680/j. 1671-3826. 2023. 11. 04.
[26]张仁杰，王宁，齐杰，等.血浆ET-1、TNF-α、sICAM-1浓度与PCI治疗后患者心肌损伤的关系[J].岭南心血管病杂志，2020, 26(3):262-267. DOI:10. 3969/j.issn. 1007-9688. 2020. 03. 03.
基本信息:
DOI：10.13242/j.cnki.bingduxuebao.250165
中图分类号:R541.4
引用信息:
[1]孙建锋,崔永攀,刘艳芳.巨细胞病毒与冠状动脉损伤的关系研究[J].病毒学报,2025,41(05):1464-1469.DOI:10.13242/j.cnki.bingduxuebao.250165.
基金信息:
中央引导地方科技发展项目(项目号：2022BGE23-7),题目：湖北省缺血性心血管疾病临床医学研究创新示范平台建设~~