急性心肌梗死病人细胞黏附分子水平的动态变化

DYNAMIC CHANGES OF CELL ADHESION MOLECULES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

目的探讨急性心肌梗死（ＡＭＩ）病人细胞黏附分子的动态变化及临床意义。②方法采用酶联免疫吸附法（ＥＬＩＳＡ），检测了６７例ＡＭＩ病人发病第１，４，７天以及３８例健康人、４２例陈旧性心肌梗死（ＯＭＩ）病人白细胞ＣＤ１８表达、血浆可溶性细胞间黏附分子－１（ｓＩＣＡＭ－１），可溶性血管细胞间黏附分子－１（ｓＶＣＡＭ－１）的变化。③结果ＡＭＩ病人白细胞ＣＤ１８表达、ｓＩＣＡＭ－１，ｓＶＣＡＭ－１浓度明显增高，与对照组和ＯＭＩ病人比较差异有极显著性（Ｆ＝１６．４２６～３４．５７０，ｑ＝８．４２３～１６．８５１，Ｐ＜０．００１）。发病第１，４，７天，白细胞ＣＤ１８表达、ｓＩＣＡＭ－１，ｓＶＣＡＭ－１浓度逐渐降低，其间的差异有极显著性（Ｆ＝１４．１０８～２２．０４３，ｑ＝６．２７５～１４．１６２，Ｐ＜０．００１）。死亡者和伴有室性心律失常者各指标增高，较存活者和无室性心律失常者更明显（ｔ＝６．３１５～１９．６０６，Ｐ＜０．００１）。ＡＭＩ病人白细胞ＣＤ１８表达与ｓＩＣＡＭ－１，ｓＶＣＡＭ－１浓度呈正相关（ｒ＝０．６６２～０．７４５，Ｐ＜０．００１）。④结论细胞黏附分子参与了ＡＭＩ的发生和发展，且与病情严重程度和预后有密切关?

Objective\ To explore the dynamic changes of cell adhesion molecules in patients with acute myocardial infarction (AMI).\ Methods\ By using enzyme linked immunosorbent assay (ELISA),the changes of the expression of leukocyte CD 18 and the concentration of soluble intercellular adhesion molecule 1 (sICAM 1) and soluble vascular cell adhesion molecule 1(sVCAM 1) were measured on the 1st,4th and 7th days in 67 patients with AMI, 42 patients with old myocardial infarction (OMI) and 38 healthy subjects.\ Results\ The expression of leukocyte CD 18 and the concentration of sICAM 1 and sVCAM 1 were higher in AMI patients than that in controls and OMI patients ( F=16.426-34.570,q=8.423-16.851,P <0.001), while on the 1st,4th and 7th days in AMI patients, the high expression of leukocyte CD 18 and the high concentration of sICAM 1 and sVCAM 1 decreased gradually ( F=14.108-22.043,q=6.275-14.162,P <0.001). The expression of leukocyte CD 18 and the concentration of sICAM 1 and sVCAM 1 were higher in patients with ventricular arrhythemia (VA) and the dead patients before the 4th day than that in the patients without VA and the survivals ( t=6.315-19.606,P <0.001). The leukocyte CD 18 expression was positively correlated to the concentration of sICAM 1 and sVCAM 1( r=0.662-0.745,P <0.001).\ Conclusion\ The dynamic changes of cell adhesion molecules may participate in the occurance and development of AMI, and have close relation with the seriouness of patients' condition and prognosis.