冠心病患者血清炎症因子水平变化及临床意义

Changes of serum level of inflammation factors in patients with coronary heart disease and the clinical significance

【目的】探讨炎症因子与冠心病发病和病变程度的关系及在病情监测中的作用。【方法】选择住院且经冠脉造影等检查确诊的冠心病患者共56例,其中不稳定性心绞痛(unstable angina pector,UAP)患者30例,急性心肌梗死(acutr myocardinl infarction,AMI)26例,并选造影正常者30例作为对照,用ELISA法测定血清可溶性细胞间粘附分子-1(sICAM-1)、血管细胞粘附分子-1(sVCAM-1)和高效C反应蛋白(hs-CRP)浓度,统计分析上述炎症因子与冠心病诊断、冠脉病变程度和危险分数间的关系。【结果】(1)血清sICAM-1、sVCAM-1水平在AMI组和UAP组均明显高于对照组,且AMI组明显高于UAP组;hs-CRP在AMI组中明显升高。(2)UAP患者血清sICAM-1和sVCAM-1与冠状动脉危险分数相关。(3)血清sICAM-1、sVICAM-1、hs-CRP水平随冠脉病变Gensini积分和狭窄程度的增加,有逐渐增高的趋势。【结论】冠心病的发生、发展过程中存在炎症反应,黏附分子与CRP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。血清sICAM-1、sVI-CAM-1、hs-CRP水平可以反映冠状动脉病变程度,并可以作为冠心病病情监测的指标。

[Objective] To investigate the relationship between levels of inflammation factors and the diagnosis and severity of coronary heart disease and their role in monitoring patient＇s condition. [Methods] A total of 56 cases of coronary heart disease were selected for study, among which 30 were diagnosed as unstable angina pectoris （UAP） and 26 acute myocardial infarction （AMI）, and 30 ＂healthy＂ people were selected as control group who were identified as normal by coronary angiography. Serum levels of soluble ICAM-1, VCAM-1 and CRP were measured by enzyme-link immunoassay. Relationship between levels of inflammation factors and diagnosis, extent of coronary lesion and jeopardy score were compored and analyzed by statistical methods. [Results] （1） Serum levels of soluble ICAM-1 and VCAM-1 were significantly higher in AMI or UAP than those in ＂healthy＂ people, and they were much higher in patients with AMI than those with UAP （ P 〈 0.05）. Serum level of high sensitive CRP was increased significantly in patients with AMI. （2） In patients with UAP serum levels of soluble ICAM-1 and VCAM-1 were correlated with coronary jeopardy score （ r = 0.445, 0.513 respectively, P 〈 0.05）. （3） Serum levels of soluble ICAM-1, VCAM-1 and hs-CRP intended to increase with coronary lesion Gensini score and extent of stenosis. [Conclusions] Inflammatory reaction exists in the initiation and development of coronary heart disease. Adhesion molecules and CRP together promot the progression of atherosclerosis, both independently and influence each other. Serum levels of soluble ICAM-1, VCAM-1 and hs-CRP reflectthe extent of coronary lesion and could be used as the condition of coronary heart disease.