腹部，心包膜及周邊皮下脂肪組織之發炎反應及脂肪激素對於冠狀動脈疾病患者的影響

Inflammatory markers and adipokines of abdominal, pericardial and peripheral fat tissues in patients with coronary artery disease

鄭凱鴻(Kai-Hung Cheng)

指導教授 ： 賴文德

高雄醫學大學/醫學院/醫學研究所/碩士(2006年)

摘要

背景—之前已被證實在嚴重之冠心症的患者，心外膜脂肪中的發炎媒介物比皮下脂肪組織來的高。脂肪組織作用如同內分泌器官而且會造成發炎負擔並會經許多脂肪激素媒介在這些有冠心病的患者。在本研究中，我們想在冠心症患者及對照組患者中比較不同的發炎指標和脂肪激素在不同來源的脂肪組織中的表現。
方法和結果— 這些心包膜，腹部及皮下組織是從要做繞道手術(冠心症)組及控制組(包括作瓣膜置換手術，心房中隔及心室中隔缺損作片狀修補者)所取得(n=46v.s.12; 年齡= 64±9 v.s.49±14 歲). 局部脂肪激素 (adiponectin, leptin, and visfatin,) 和發炎激素(interleukin -6[IL-6], and tumor necrosis factor [TNF]-α) 的表現是用ELISA來分析 (蛋白質要經3小時釋放)。 結果顯示腹部脂肪組織中的這些IL-6, TNF-α,leptin, 和visfatin protein 是顯著地比較高，之後是心包膜而最低是皮下脂肪組織，而 Adiponectin 的情形則是相反的。 IL-6, TNF-α,leptin, 和 visfatin 在冠心症患者的任一脂肪組織都比對照組相對的部份明顯來的高。 Adiponectin 在這方面也是相反的。在冠心症組， leptin 的血中濃度與皮下脂肪組織中的量有比較強的正相關。在對照組， TNF-α 的血中濃度跟心包膜脂肪組織中的量有比較強的負相關。
總結—腹部脂肪組織在粥狀動脈硬化，胰島素阻抗性和代謝症候群中可能扮演著最重要的角色，接著是心包膜脂肪組織而皮下脂肪組織是最少的。

關鍵字

脂肪組織 ； 脂肪激素 ； 冠狀動脈疾病 ； 發炎指標

並列摘要

Background—It has been shown that inflammatory mediators in epicardial fat is higher than subcutaneous adipose stores in patients with critical coronary artery disease (CAD) was identified before. Adipose tissue functions as an endocrine organ and might contribute to an inflammatory burden which mediated by many adipokines in patients with CAD. In this study, we compare the expression of different inflammatory markers and adipokines in various origins of adipose tissues from CAD patient group and control group.
Methods and Results—Samples of pericardial ,abdominal and subcutaneous adipose tissues were harvested at the outset of elective coronary artery bypass grafting(CABG) surgery (CAD group) and control group( including valve replacement surgery, patch repair of atrial septal defect and ventricular septal defect) (n=46v.s.12; age= 64±9 v.s.49±14 years). Local expression of adipokines (adiponectin, leptin, and visfatin,) and inflammatory cytokines [interleukin -6(IL-6), and tumor necrosis factor (TNF)-α] was analyzed by ELISA (protein release over 3 hours). Significantly higher levels of IL-6, TNF-α,leptin, and visfatin protein were observed in abdominal visceral adipose tissue, followed by pericardial and the lowest in subcutaneous adipose stores. Adiponectin has the opposite results. IL-6, TNF-α,leptin, and visfatin were significantly higher in any sort of adipose tissue in CAD group compared to the control group. Adiponectin also has the opposite effect, too. In CAD group, plasma leptin level of has stronger positive correlation with that of subcutaneous adipose tissue expression. In control group, plasma TNF-α level has stronger negative correlation with that of pericardial adipose tissue level.
Conclusions—Abdominal visceral adipose tissue might play the most important role in atherosclerosis , insulin resistance and metabolic syndrome, followed by pericardial adipose tissue, and the least in subcutaneous adipose tissue.

並列關鍵字

adipose tissue ； adipo(cyto)kine ； coronary artery disease ； inflammatory marker

參考文獻

1. Tomasz Mazurek, et al, Human Epicardial Adipose Tissue Is a Source of Inflammatory Mediators Circulation, 2003. 108: p. 2460-2466.

2. Peter Libby, et al, Inflammation and Atherosclerosis. Circulation, 2002. 105: p. 1135 - 1143.

3. Patino WD, et al,Atherosclerotic Plaque Macrophage Transcriptional Regulators Are Expressed in Blood and Modulated by Tristetraprolin. Circ Res., 2006

4. Edward T.H.,et al, CRP as a Mediator of Disease. Circulation 2004. 109: p. II-11 - II-14.

5. N. Busso, et al, Leptin signaling deficiency impairs humoral and cellular immune responses and attenuates experimental arthritis. J Immunol 2002. 168: p. 875–882.