冠状动脉病变程度及受累支数与血内皮素和可溶性细胞间黏附分子1水平:与健康对照组对比观察

Association of the severity of coronary artery disease and number of diseased arteries with the levels of plasma en-dothelin and soluble intercellular adhesion molecule-1:Com-parison with healthy control group

目的:探讨不同临床表现及存在不同冠状动脉的受累数量的冠心病患者血内皮素和可溶性细胞间黏附分子1的变化及其意义,并与健康者进行对照。方法:①选择2003-08/2004-04在中国医科大学附属第一医院循环内科住院的冠心病患者45例。患者均知情同意。心肌梗死患者14例(心肌梗死组);不稳定型心绞痛19例(不稳定型心绞痛组);稳定型心绞痛12例(稳定型心绞痛组)。同期选择本院健康体检者15例为对照组。根据冠状动脉造影结果,设冠状动脉单支病变患者29例为单支病变组,冠状动脉多支病变患者16例为多支病变组。②血浆内皮素测定按放射免疫药盒说明完成;血清可溶性细胞间黏附分子1的测定采用酶联免疫吸附法。结果:冠心病患者45例和健康者15人均进入结果分析。①血内皮素和可溶性细胞间黏附分子水平:稳定型心绞痛组与对照组相近;心肌梗死组和不稳定型心绞痛组明显高于稳定型心绞痛组和正常对照组(P<0.01);心肌梗死组明显高于不稳定型心绞痛组(P<0.05)。随冠状动脉狭窄支数的增加,血内皮素和可溶性细胞间黏附分子1水平:有增高趋势。单支病变组和多支病变组明显高于与对照组(P<0.01)。多支病变组明显高于单支病变组(P<0.05)。②血内皮素和可溶性细胞间黏附分子1水平的相关性:冠心病患者内皮素和可溶性细胞间黏附分子1水平呈显著正相关(r=0.612,P<0.05)。结论:①内皮素可能与冠状动脉病变的严重程度有关,可溶性细胞间黏附分子1在判断动脉粥样硬化病变活动方面具有预测性。②可溶性细胞间黏附分子1与内皮素在动脉粥样硬化形成过程中既相互独立又彼此影响,共同促进动脉粥样硬化的发展。

AIM：To probe into the changes and clinical significance of plasma endothelin and soluble intercellular adhesion molecule-1 in patients with coronary heart disease of different clinical manifestations and different number of diseased arteries, and compare with healthy peoples. METHODS：Between August 2003 and April 2004,45 inpatients with coronary heart disease,including 14 cases of myocardial infarction （myocardial infarction group）,19 cases of unstable angina pectoris （unstable angina pectoffs group）,12 cases of stable angina pectoris （stable angina pectoffs group）, were selected from the Department of Cardiology,the First Affiliated Hospital of China Medical University.Another 15 healthy physical examinees in the hospital at the same period were taken as the controls （control group）.According to the results of coronary arteriongraphy,the patients were divided into single arterial lesion group （n=29） and multiple arterial lesion group （n= 16）.②The plasma endothelin was detected according to the instruction of the radioimmune kit,serum soluble intercellular adhesion molecule-1 was detected with enzyme-linked im munosobent assay （ELISA）. RESULTS： All the 45 patients with coronary heart disease and 15 healthy people were involved in the analysis of results. ①The levels of plasma endothelin and soluble intercellular adhesion molecule-1The levels were close between the stable angina pectoris group and control group, obviously higher in the myocardial infarction group and unstable angina pectoffs group than in the stable angina pectoris group and normal control group （P 〈 0.01）, and also obviously higher in the myocardial infarction group than in the unstable angina pectoris group （P 〈 0.05）. With the increase of the number of stenosis arteries, the levels of plasma endothelin and soluble intercellular adhesion molecule-1 showed an rising trend, and the levels were obviously higher in the single arterial lesion group and multiple arterial lesion group than in the control group （P 〈 0.01）, also obviously higher in the single arterial lesion group than in the multiple arterial lesion group （P 〈 0.05）. ②Correlation between plasma endothelin and soluble intercellular adhesion molecule-1 There was a significant positive correlation between them in the patients with coronary heart disease （r=-0.612, P 〈 0.05）. CONCLUSION： ① It is indicated that endothelin may be associated with the severity of coronary artery disease,and soluble intercellular adhesion molecule-1 plays a role in predicting the activity of atheromatosis. ②Soluble intercellular adhesion molecule-1 and plasma en-dothelin are both independent from each other and have interactions dur-ing the formation of atheromatosis, and they accelerate the development of atheromatosis together.