冠状动脉无复流患者内皮微粒变化的临床意义

Changes of endothelial microparticles and slCAM - 1 in AMI patients with no - reflow after per- cutaneous coronary intervention

目的评价急性心肌梗死（AMI）行急诊冠脉介入治疗（PcI）后发生无复流患者循环血中内皮微粒（EMP）和可溶性细胞间黏附分子-1（sICAM-1）变化的临床意义。方法将行急诊PCI治疗的AMI患者64例根据术后TIMI血流分级随机分为两组，冠状动脉前向血流≤TMI2级23例为无复流组，TIMI3级41例为再灌注组，另以20例健康人为对照组。分别于急诊入院时、再灌注后即刻和再灌注后24h采集静脉血，采用流式细胞术（FCM）测定患者血浆EMP水平，采用酶联免疫吸附法（ELISA）测定血清sICAM—1水平。结果再灌注组和无复流组各时点EMP和sICAM-1水平明显高于对照组（P均〈0．05）；无复流组各时点EMP和sICAM—1水平明显高于再灌注组（P均〈0．05）；再灌注组和无复流组再灌注后即刻和再灌注后24hEMP和slCAM—l水平仍高于入院时（P均〈0．05）。EMP与sICAM—1水平呈正相关（r=0．35，P：0．003）。结论EMP在评价PCI术后无复流患者冠脉内皮炎症反应和损伤程度方面具有一定的临床意义。

Objective To evaluate the clinical value of endothelial microparticles （EMP） and soluble intercellular adhesion molecule - 1 （ sICAM - 1 ） as specific markers of endothelial dysfunction in acute myocardial infarction （ AMI ） patients with no - reflow after primary percutaneous coronary intervention （ PCI ）. Methods 64 patients of AMI with PCI were randomly divided into no - reflow group （n = 23） and the reperfusion group （n = 41 ）, and 20 healthy subjects （control group） were enrolled in the study. TIMI flow was examined angiographically after PCI. EMP was measured by flow cytometry （ FCM ） and level of sICAM - 1 was tested by enzyme linked immunosorbent assay （ ELISA ）. Resulfs Compared with the control group, no - reflow group and reperfusion group had higher level of EMP and sICAM - 1 at all time points （ P 〈 0.05 ）. The levels of EMP and sICAM - 1 in no - reflow group were markedly increased, compared with the reperfusion group at all time points （P 〈 0.05 ）. The levels of EMP and sICAM - 1 in no - reflow group and the reperfusion group were significantly higher at immediate time point and 24 h time point than at admission to hospital （ P 〈 0.05 ）. There were positive correlation between EMP and sICAM - 1 （ r = 0.35, P = 0. 003 ）. Conclusion The EMP and sICAM may be of clinical significance in evaluating the endothelial inflammation and dysfunction of AMI patients with no - reflow after PCI.