急性冠脉综合征患者经皮冠脉介入治疗前后血浆内皮素系统的变化及临床意义

Change and clinical significance of plasma endothelin system before and after PCI in patients with acute coronary syndrome

目的研究急性冠脉综合征(ACS)患者经皮冠脉介入治疗(PCI)前后不同时限血浆内皮素(ET)水平及外周血单个核细胞ETA及ETB受体表达的变化及其临床意义。方法选取2008年10月～2009年2月住院并接受PCI治疗的ACS患者40例(ACS组),包括ST段抬高型心肌梗死(STEMI)26例(STEMI组),非ST段抬高型心肌梗死(NSTEMI)9例(NSTEMI组),不稳定型心绞痛(UA)5例(UA组);选择同期健康体检者20例为对照组。采用酶联免疫法测定对照组及ACS组PCI治疗前后不同时限血浆ET-1水平,同时用半定量RT-PCR方法测定外周血单个核细胞表面ETA及ETB受体的表达。结果①PCI术前1 h STEMI组、NSTEMI组、UA组间ET-1水平差异无统计学意义(P>0.05),但均高于对照组,差异有高度统计学意义(P<0.01);术后24 h STEMI组、NSTEMI组、UA组ET-1水平均高于同组术后12 h,差异有统计学意义(P<0.05);术后7 d STEMI组、NSTEMI组、UA组ET-1水平与同组术后24 h差异无统计学意义(P>0.05);术后3个月STEMI组、NSTEMI组、UA组ET-1水平均低于同组术后7 d水平,差异有统计学意义(P<0.05),且与同组术前1 h水平差异无统计学意义(P>0.05)。②PCI术前1 h STEMI组、NSTEMI组、UA组ETA mRNA、ETB mRNA表达水平均高于对照组,差异有高度统计学意义(P<0.01);术后24 h STEMI组、NSTEMI组、UA组ETA mRNA、ETB mRNA表达水平均高于同组术后12 h,差异有统计学意义(P<0.05);术后7 d STEMI组、NSTEMI组、UA组ETA mRNA、ETB mRNA表达水平与同组术后24 h比较,差异无统计学意义(P>0.05);术后3个月STEMI组、NSTEMI组、UA组ETA mRNA、ETB mRNA表达水平均低于同组术后7 d水平,差异有统计学意义(P<0.05)。结论 ET系统在PCI术后血管内皮增殖中起着重要作用,可能与再狭窄的发生相关。

Objective To investigate the changes of serum ET-1 level and expression of endothelin A and endothelin B receptor mRNA in peripheral blood monocytes in patients with acute coronary syndrome（ACS） before and after the percutaneous coronary intervention（PCI）.Methods 40 patients with ACS and PCI（ACS group） from October 2008 to February 2009 were selected and divided into STEMI group with 26 cases,NSTEMI group with 9 cases,UA group with 5 cases;20 cases of healthy people in the same term were selected as control group.Plasma ET-1 level in control group and ACS group before and after the PCI were detected by euzymelinked immunosorbent assay,expression of E TA and ETB receptor mRNA in peripheral blood monocytes were detected by semiquantitative RT-PCR.Results ① The differences of ET-1 level in STEMI group,NSTEMI group,UA group 1 hour before the PCI were not statistically significant（P 0.05）,they were all higher than those in control group,the differences were statistically significant（P 0.01）;ET-1 level in STEMI group,NSTEMI group,UA group 24 hours after the PCI were all higher than those 12 hours after the PCI in the same group,the differences were statistically significant（P 0.05）;the differences of ET-1 level in STEMI group,NSTEMI group,UA group between 7 days and 24 hours after the PCI were not statistical ly significant（P 0.05）;ET-1 level in STEMI group,NSTEMI group,UA group 3 months after the PCI were all lower than those 7 days after the PCI in the same group,the differences were statistically significant（P 0.05）;compared with the same group 1 hour before the PCI,the differences were not statistically significant（P 0.05）.②Expression of ETA mRNA,ETB mRNA in STEMI group,NSTEMI group,UA group 1 hour before the PCI were all higher than those in control group,the differences were statistically significant（P 0.01）;the expression of ETA mRNA,ETB mRNA in STEMI group,NSTEMI group,UA group 24 hours after the PCI were higher than those 12 hours after the PCI in the same group,the differences were statisti-cally significant（P 0.05）;the differences of expression of ETAmRNA,ETB mRNA in STEMI group,NSTEMI group,UA group between 7 days and 24 hours after the PCI were not statistically significant（P 0.05）;expression of ETA mRNA,ETB mRNA in STEMI group,NSTEMI group,UA group 3 months after the PCI were all lower than those 7 days after the PCI in the same group,the differences were statistically significant（P 0.05）.Conclusion The ET system may play an important role in the pathophysiological process of endothelial proliferation,which is closely related to restenosis in patients after PCI.