急性心肌梗死患者血浆可溶性E-选择素的检测及其临床意义

Soluble E-selectin in patients with acute myocardial infarction

目的 :探讨心肌缺血 /再灌注与血管内皮急性炎症之间的关系及其与急性心肌梗死 (AMI)发病形式的关系。方法 :受试者分为 AMI组 4 3例 (发病 6 h内 ) ,其中 2 2例梗死前有不稳定心绞痛史 ,2 1例为猝发梗死 ;稳定劳力型心绞痛 (SEA)组 39例。AMI组分别于入院时、再灌注后即刻、入院后 4 ,8,12 ,2 4 h及 2 ,3,5 d和 1,2周时抽外周静脉血测血浆可溶性 E-选择先 (s E- SL T)。SEA组于入院时空腹及仰卧位抽外周静脉血测血浆 s E- SL T。结果 :入院时 AMI组血浆 s E- SL T水平高于 SEA组 (39.2± 2 .9vs 2 7.8± 2 .1μg/ L ,P<0 .0 1)。另外 ,入院时梗死前前驱症状为不稳定心绞痛的 AMI患者血浆 s E- SL T水平还高于猝发梗死者 (45 .6± 5 .7vs32 .8± 1.9μg/ L,P<0 .0 5 )。AMI患者梗死前前驱症状为不稳定心绞痛者及猝发梗死者的血浆 s E- SL T水平随时间推移均缓慢下降 (相应从4 5 .6± 5 .7到 32 .7± 2 .5 μg/ L,P<0 .0 1和从 32 .8± 1.9到 2 1.5± 1.6 μg/ L,P<0 .0 1) ,而且前者的血浆 s E- SL T水平各时段均高于后者 (P<0 .0 5 ,P<0 .0 1)。结论 :AMI患者血浆 s E- SL T水平升高反映了血管内皮细胞活性增强。梗死前前驱症状为不稳定心绞痛的 AMI患者血浆 s E- SL T水平升高 。

AIM: To determine the relation between myocardial ischemia/reperfusion and acute inflammation of the vascular endothelium in patients with acute myocardial infarction (AMI). METHODS: We examined the plasma sE selectin level in 43 patients within 6 hours after the onset of AMI and in 39 patients with stable exertional angina(SEA) and 29 control patients. In the AMI group blood samples were obtained on admission, after reperfusion therapy, and at 4 h, 8 h, 12 h, 24 h, 48 h, 3 d, 5 d, 1 week, and 2 weeks after admission. In this group, 22 patients had a history of prodromal unstable angina(UA) before infarction and 21 had sudden onset of infarction(SI). Venous blood samples were also obtained from the SEA group in the fasting state and the supine position. RESULTS: The plasma sE selectin level on admission was higher in AMI group than in the SEA group (39.2±2.9 vs 27.8±2.1 μg/L, P <0.01). In addition, plasma sE selectin levels in the AMI group with prodromal UA were higher than in those with SI on admission(45.6±5.7 vs 32.8±1.9 μg/L, P <0.05). The plasma sE selectin level decreased slowly during the chronic phase both in patients with AMI with prodromal UA (from 45.6±5.7 to 32.7±2.5 μg/L, P <0.01) and those with SI (from 32.8±1.9 to 21.5±1.6 μg/L, P <0.01). However, sE selectin levels were significantly higher at any time in the former than in the latter ( P <0.05,except at 48 hours after admission, P <0.01).CONCLUSIONS: An increase of sE selectin may reflect enhanced endothelial cell activation in patients with AMI. The higher sE selectin level in patients with prodromal UA may be associated with repeated episodes of myocardial ischemia and reperfusion.