通心络对不稳定型心绞痛患者循环内皮微粒的影响

Effect of Tongxinluo （通心络 ） on endothelial micro-particles in patients with unstable angina

目的观察通心络对循环血内皮微粒（EMPs）和可溶性细胞间黏附分子-1（sICAM-1）的影响，并探讨EMPs和sICAM-1作为评价不稳定型心绞痛（UA）患者内皮炎症和损伤程度的可行性。方法将72例UA患者随机分为常规治疗组（38例）和通心络组（34例），另以24例健康者作为对照组。常规治疗组给予常规西药治疗；通心络组在常规治疗基础上加用通心络胶囊4粒、每日3次；两组均治疗4周。于治疗前后采集患者静脉血，用流式细胞仪（FCM）测定血中EMPs水平，用酶联免疫吸附法（ELLSA）测定血中sICAM-1水平；并分析EMPs与sICAM-1的相关性。结果通心络组和常规治疗组治疗前EMPs和sICAM-1水平均明显高于健康对照组。治疗4周后，两组EMPs和sICAM-1水平虽仍高于健康对照组，但均较治疗前明显下降，且通心络组较常规治疗组下降更为明显[EMPs（个／μl）：693．2（496．7～1043．2）比905．3（646．1～1304．7）；sICAM-1（μg／L）：178．4（148．3～254．7）比237．4（173．6～308．4），均P〈0．053。EMPs与siCAM-1呈显著正相关（r=0．827，P〈0．01）。结论通心络可明显降低uA患者EMPs和sICAM-1水平，其作用与稳定冠状动脉粥样硬化斑块和抑制内皮炎症有关；EMPs对评价UA患者冠状动脉粥样硬化斑块稳定性及内皮炎症反应和损伤程度具有-定临床意义。

Objective To explore the effect of Tongxinluo （通心络） on endothelial micro-particles （EMPs） and soluble intercellular adhesion molecule-1 （sICAM-1） in circulatory blood, and to determined the feasibility of EMPs and sICAM-1 as specific markers of endothelial inflammation and dysfunction in patients with unstable angina （UA）. Methods Seventy-two patients with UA were randomly divided into conventional treatment group （38 eases） and Tongxinluo group （34 cases）, and 24 healthy subjects were enrolled as control group in the study. The conventional treatment group was treated with conventional western medicine only, while the Tongxinluo group received additional Tongxinluo capsule 4 pills, three times a day. The course of treatment in both groups was 4 weeks. Before and after the treatment, the venous blood was collected and the level of EMPs was measured by flow cytometry, while the level of sICAM-1 was tested by enzyme linked immunosorbent assay （ELISA） in all the cases. A correlation analysis was conducted between EMPs and sICAM-1. Results Compared with the control group, Tongxinluo group and conventional treatment group had higher levels of EMPs and sICAM-1 before treatment. Though the levels of EMPs and sICAM-1 in both treatment groups were still significantly higher than those in control group, decreased obviously after 4-week treatment, and the decreasing extent of EMPs and sICAM-1 in Tongxinluo group was greater than that in conventional treatment group 【EMPs （counts/μl） ： 693.2 （496.7 1 043.2） vs. 905.3 （646.1 1 304.7）, sICAM-1 （btg/L）： 178.4 （148.3 254.7） vs. 237.4 （173.6 -308.4）, both P〈0.05]. The EMPs was significantly positively correlated with sICAM-1 （r = 0. 827, P ~ 0.01）. Conclusion Tongxinluo may significantly reduce the levels of EMPs and sICAM in patients with UA, and it can be concluded tentatively that stabilizing the coronary vulnerable plaque and inhibiting the endothelial inflammatory reaction are some of the mechanisms. EMPs may be of clinical significance to evaluate the stability of plaque and the endothelial inflammation and dysfunction in patients with UA.