脑梗死动脉粥样斑块及其稳定性与细胞间黏附分子-1的相关性研究

Association between Atherosclerosis Plaques and Soluble Intercellular Adhesion Molecule-1 Level in Cerebral Infarction Patients

目的:探讨脑梗死动脉粥样硬化(AS)斑块及其稳定性与细胞间黏附分子-1(ICAM-1)的相关性。方法:脑梗死患者87例,根据入院颈动脉彩超检查情况分为两大组:AS斑块阴性组及阳性组,后组又根据经颅多普勒超声(TCD)微栓子信号(MES)检测情况分为MES阴性组和MES阳性组。比较3组入院时可溶性细胞间黏附分子-1(sICAM-1)水平,并对MES阳性组予低分子肝素钠(LWMH)等干预治疗,分别于治疗前,治疗后1周、2周、4周检测血清sICAM-1浓度,结果:各组sICAM-1人院时均偏高,AS斑块阳性的两组明显高于阴性组(P<0.01),且MES阳性组较阴性组也有明显增高(P<0.05);MES阳性组干预治疗后sICAM-1呈下降趋势,于第2周达低峰,但第4周又有上升。结论:AS斑块的形成及破裂与ICAM-1密切相关,sICAM-1可作为脑梗死病情变化的监测指标,在老年人群中尝试常规抗炎治疗为防治脑梗死拓宽了思路。

Objective： To evaluate the association between atherosclerosis （AS） plaques and the level of soluble intercellular adhesion molecule-1 （sICAM-1） in cerebral infarction patients. Methods： According to the results of AS plaques explored with carotid artery ultrasound at hospitalization, 87 patients （49 males, 38 females, range from 44 to 79 years old and average 59±18 years old） with cerebral infarction were divided into two main groups： AS plaque negative group and AS plaque positive group. AS plaque positive group were divided into two subgroups according to the results of microembolic signals （MES） detected by transcranial Doppler （TCD）, i.e. MES negative group and MES positive group, sICAM-1 levels were measured by radioimmunoassay at hospitalization and were compared between every two groups. In MES positive group, the patients were treated with low molecular heparin sodium （LWMH）. The sICAM-1 levels were measured before therapy and at the end of the 1^st, 2^nd, 4^th week after treatment respectively. Results： The levels of sICAM-1 in all groups were beyond the reference. The levels of sICAM-1 in MES negative group （701.3±27. 4 ng/ml） and MES positive group （892. 4 ±30. 5ng/ ml） were higher （P〈0. 01 ） than which in AS plaque negative group （478. 9±31.6 ng/ml）, sICAM-1 levels were higher in MES positive group than in MES negative group （P〈0. 05）. In MES positive group, sICAM levels tended to decrease after the treatment with LWMH. It reached the lowest point at 492. 3±34. 1ng/ml at the end of the 2^nd week, and then it increased and reached 615. 4±27. 4ng/ ml at the end of the 4^th week. Conclusion：The formation and cracking of the AS plaques may be associated with the sICAM-1. The level of sICAM-1 may be an index in monitoring the state of cerebral infarction. Applying anti-inflammation therapy routinely in older population will be beneficial to preventing and treating cerebral infarction.