急性冠状动脉综合征患者血清细胞粘附分子的变化

Changes in serum cell adhesion molecules in patients with acute coronary syndrome

目的 :观察急性冠状动脉综合征患者血清可溶性细胞粘附分子 1 (ICAM 1 )、血管细胞粘附分子 1(VCAM 1 )、E 选择素 (E S)和血管性假血友病因子 (v WF)的变化以及急性心肌梗死 (AMI)患者成功再灌注后上述指标的动态变化。方法 :急性冠状动脉综合征组 37例中 AMI 2 1例 ,随机接受直接冠状动脉腔内成形术或溶栓治疗 ,于再灌注治疗前和治疗后 1 2、2 4、48和 72小时各抽血 1次 ,心绞痛患者 1 6例和正常对照组 40例抽血 1次。指标测定用双抗体夹心 EL ISA法。结果 :急性冠状动脉综合征组 ICAM 1、VCAM 1、E S和v WF测值分别为 (2 77.5± 6 8.2 ) μg/ L,(885 .3± 1 83.2 ) μg/ L,(5 7.6± 8.9) μg/ L 和 (1 39.9± 2 8.7) μg/ L,均显著高于正常对照组 ,分别为 (2 1 0 .7± 5 8.8) μg/ L(P<0 .0 5 ) ,(6 1 1 .4± 74.6 ) μg/ L(P<0 .0 5 ) ,(44 .9± 6 .2 ) μg/ L(P<0 .0 1 )和 (1 0 6 .6± 36 .1 ) μg/ L(P<0 .0 5 ) ;与治疗前相比 ,1 6例 AMI再灌注治疗成功患者的 ICAM 1、E S测值在 2 4和 48小时后显著降低 (P均 <0 .0 5 ) ,VCAM 1在 2 4和 72小时后显著降低 (P均 <0 .0 5 ) ,v WF在 1 2、2 4、48和 72小时后显著降低 (P<0 .0 5或 P<0 .0 1 ) ;而 5例再灌注治疗不成功患者上述测值均无显著降低 ;

Objective:To observe the changes in serum soluble intercellular adhesion molecule1 (ICAM1),vascular cell adhesion molecule1 (VCAM1),Eselectin and von Willebrand factor (vWF) in patients with unstable angina pectoris and acute myocardial infarction (AMI) after reperfusion.Methods:Venous blood samples were taken from 37 patients with acute coronary syndrome.Blood samples were taken from 21 of those with AMI before and 12,24,48,72 hours after thrombolytic treatment or direct PTCA.40 normal subjects were used as control.Serum concentrations of ICAM1,VCAM1,Eselectin and vWF were determined using double antibodies sandwich enzymelinked immunosorbent assay.Results:Serum levels of ICAM1,VCAM1,Eselectin and vWF were higher in patients with acute coronary syndrome than those in control subjects 〔(277 5±68 2)μg/L vs.(210 7±58 8)μg/L ( P <0 05),(885 3±183 2)μg/L vs.(611 4± 74 6)μg/L ( P <0 05),(57 6±8 9)μg/L vs.(44 9±6 2)μg/L ( P <0 01) and (139 9±28 7)μg/L vs.(106 6±36 1)μg/L ( P <0 05),respectively〕.In AMI subgroup,16 patients who had successful treatment showed significant reduction in serum concentrations of ICAM1 and Eselectin at 24 and 48 hours (all P <0 05),VCAM1 at 24,72 hours (all P <0 05) and vWF at 12,24,48 and 72 hours ( P <0 05 or P <0 01) while 5 patients with failure in treatment showed no significant changes as compared with those in AMI.The numbers of coronary artery involved were not related to the levels of ICAM1,VCAM1 and Eselectin.Conclusions:The cardiovascular endothelial cells were activated and the plasma level of certain soluble cell adhesion molecules were elevated in patients with acute coronary syndrome.Successful reperfusion therapy was helpful for the recovery of the endothelial function and the reduction of the soluble cell adhesion molecules in patients with AMI.