老年急性冠脉综合征患者血小板活化和血管内皮损伤指标的改变及其临床意义

Change of Platelet Activity and Vascular Endothelium Injury Index in Elderly Patients with Acute Coronary Syndrome and Its Clinical Significance

目的观察老年急性冠脉综合征(ACS)患者血小板活化指标[CD62p、CD63、GPⅡb/Ⅲa受体复合物以及纤维蛋白原(FIB-C)]和血管内皮损伤指标[假血友病因子(vWF)、内皮素1(ET-1)、一氧化氮(NO)和内皮依赖性血管舒张功能(FMD)]的改变及其临床意义。方法60例ACS患者入院后次日采用流式细胞仪检测CD62p、CD63及GPⅡb/Ⅲa;用散射比浊法测定血浆FIB-C的水平;用双抗体夹心固相酶联免疫吸附试验测定血浆vWF的表达水平;用放射免疫测定法测定血浆ET-1表达水平;用酶法测定血浆NO的含量;用彩色多谱勒超声诊断仪测量FMD。选择健康体检者和稳定型心绞痛患者各30例作对照,观察ACS患者上述指标的变化,并与对照组比较。结果ACS患者血小板活化指标CD62p、CD63、FIB-C及GPⅡb/Ⅲa受体复合物较健康对照组明显增高(均P<0.01),较稳定型心绞痛组也增高(P<0.01或P<0.05)。血管内皮损伤指标vWF和ET-1的表达水平较健康对照组明显增高(均P<0.01),较稳定型心绞痛组也增高(均P<0.01);FMD和血浆NO的表达水平较健康对照组显著降低(P<0.01或P<0.05),较稳定型心绞痛组也显著降低(P<0.01或P<0.05)。结论血小板活化和血管内皮损伤在老年ACS患者发生和发展过程中起重要的作用。

Objective To observe the changes of serum level of the CD62p,CD63,GPⅡb/Ⅲa and fibrinogen C（FIB-C） which indicate the platelet activity and serum level of von willebrand factor（vWF）,flow-mediated dilatation（FMD）,endothelium 1（ET-1）,nitrogen oxide（NO） which indicate function of vascular endthelium in patients with acute coronary syndrome（ACS）.MethodsWe examined 60 ACS patients＇ blood levels of CD62p,CD63,GPⅡb/Ⅲa with flow cytometer,FIB-C with nephelometry,vWF with double-antibody sandwich enzyme-linked immunosorbent assay,ET-1 with radioimmunoassay,NO with the method of nitric acid reductase and FMD in brachial artery at the same time using ultrasonography on the second day after admission.And choose 30 healthy people and 30 SAP patients as the control groups,observe these indicators changes of these ACS patients and compared with the control groups.Results The ACS patients＇ blood CD62p,CD63,GPⅡb/Ⅲa and FIB-C levels increased significantly compared with healthy control group （all P0.01）and stable angina pectoris（SAP） （P0.01 or P0.05）.The blood vWF and ET-1 levels of ACS patient increased significantly compared with healthy control group（all P0.01）,and also increased compared with SAP group（all P0.01）;FMD and NO decreased significantly compared with healthy control group（P0.01 or P0.05） and also decreased significantly with SAP group（P0.01 or P0.05）.Conclusion Platelet activation and vascular endothelial cell impairment played an important role in the occurrence and development of ACS in elderly patients.