冠心病病人红细胞变形能力与血浆、红细胞膜硒浓度的关系

Correlation Between Erythrocyte Deformability and Selenium Concentration in Plasma and Erythrocyte of Patients With Coronary Heart Disease

目的：从硒与红细胞膜收缩蛋白的关系探讨冠心病病人红细胞变形能力变化的机制。方法：检测１３５例冠心病病人（不稳定性心绞痛４８例，急性心肌梗死５０例，陈旧性心肌梗死３７例）和６６例健康人血浆硒，红细胞膜硒和脂质过氧化物浓度、收缩蛋白二聚体（下简称二聚体）、收缩蛋白四聚体（下简称四聚体）及红细胞变形能力的变化。结果：冠心病病人红细胞滤过指数明显增高，血浆、红细胞膜硒浓度明显降低，与对照组比较有极显著性差异（Ｐ＜０．００１）；冠心病病人红细胞膜脂质过氧化物、二聚体、二聚体与四聚体比值增高，四聚体明显减少，与对照组比较有极显著性差异（Ｐ＜０．００１）。急性心肌梗死病人上述变化均较不稳定性心绞痛和陈旧性心肌梗死病人更明显。冠心病病人红细胞滤过指数与血浆、红细胞膜硒浓度呈负相关（ｒ＝－０．５２４和－０．６６１，Ｐ＜０．００１），红细胞膜硒浓度与脂质过氧化物、二聚体、二聚体与四聚体比值呈负相关（ｒ＝－０．５２１、－０．５７９和－０．５８６，Ｐ＜０．００１），与四聚体呈正相关（ｒ＝０．５５０，Ｐ＜０．００１）。结论：冠心病病人硒缺乏引起的膜骨架结构蛋白异常是红细胞变形能力降低的原因之一。

Objective:To explore the mechanisms of the changes of erythrocyte deformability(ED)in patients with coronary heart disease(CHD) by studying the correlation between selenium(Se)and spectrin(SP)of erythrocyte membrane. Methods:Plasma selenium(P Se),erythrocyte selenium(E Se),lipid peroxide(LPO),spectrin dimers(SP D) and spectrin tetramers(SP T) of erythrocyte membrane and ED were measured in 135 cases of CHD including 48 of unstable angina(UA),50 of acute myocardial infarction (AMI) and 37 of old myocardial infarction(OMI),and 66 controls. Results:The erythrocyte filtration index(IF) was higher,and P Se,E Se were lower in patients than those in controls( p <0 001).The LPO, SP D,SP D/SP T of erythrocyte membrane were markedly higher,and SP T was markedly lower in patients than those in controls( p <0 001) The changes of all the parameters in AMI patients were more obvious than those in UA and OMI patients.The IF was negatively correlated to P Se,E Se in patients( r =-0 524, -0 661 , p <0 001),the E Se was negatively correlated to the LPO,SP D and SP D/SP T( r =-0 521, -0 579 ,-0 586,respectively, p <0 001),positively correlated to SP T( r =0 550, p <0 001). Conclusion:The abnormality of erythrocyte spectrin caused by selenium deficiency is one of the important factors leading to the decrease of ED in coronary heart disease. [WT5”HZ〗