急性冠脉综合征患者循环中可溶性粘附分子变化的意义

Changes of the circulating soluble adhesion molecules-1 in patients with coronary artery disease

目的 为探讨急性冠状动脉综合征 (ACS)发病的部分机制 ,我们分析了ACS患者的血液中细胞间黏附分子 (ICAM -1)、血管细胞黏附分子 (VCAM -1)的变化情况。方法 入选ACS者 2 2例 ,其中不稳定型心绞痛 (UAP)者 10例、急性心肌梗死 (AMI)者 12例 ;另有稳定型心绞痛 (SAP)者 10例、健康 (Control)者 10例作为对照。采用ELISA法检测血清ICAM -1、VCAM -1水平。结果 SAP组、UAP组和AMI组血清sICAM -1浓度均显著高于对照组 ,UAP组或AMI组血清sICAM -1浓度也显著高于SAP组 ,P <0 .0 1;而UAP组和AMI组间血清sICAM -1浓度的差异无统计学意义 (P >0 .0 5 )。SAP组、UAP组、AMI组和对照组四组间血清sVCAM -1浓度无明显差异 (P >0 .0 5 )。结论 ICAM -1可能参与了冠心病的发病过程 ,其高低并与病变的活动性有关 ,尤其是在ACS中 ,ICAM -1均明显增高 ,因此 ,检测血清ICAM

Objective: To understand some pathophysiology of coronary artery disease(CAD),the changes of the circulating soluble intercellular adhesion molecules-1 (sICAM-1) and soluble vascular cell adhesion molecules-1 (sVCAM-1) in patients with coronary artery disease were analysed.Methods According to the condition,patients were divided into four groups:10 patients with stable angina pectoris (SAP group),10 patients with unstable angina pectoris (UAP group),12 patients with acute myocardial infarction (AMI group) and 10 healthy subjects (control group).Diagnosis of CAD in patients with angina pectoris was based on stenosis by>50% diameter narrowing in coronary artery documented by coronary angiography.AMI was confirmed by clinical manifestation,appearance of a new Q wave or ST elevation on electrocardiogram and increasing of serum creatinine kinase (>2 times upper normal value).SAP patients were defined as 'inactive' CAD patients,and UAP,AMI patients as 'active' CAD patients.Blood samples were drawn in the second day after hospitalization in angina patients and at admission in AMI patients.Serum concentrations of sICAM-1 and sVCAM-1 were measured by enzyme-linled immunosorbent assay(ELISA).Results:The levels of sICAM-1 in SAP group,UAP group and AMI group were much higher than thsoe in conttrol group,P<0.05 or 0.01.Also,the levels of sICAM-1 in UAP or AMI group were significantly higher than those in SAP group.But there were no different between UAP and AMI groups.Correlation analysis showed that the levels of sICAM-1 were significantly correlated with the activity of CAD.There were no obviously differences in sVCAM-1 among four groups.Conclusion:The levels of sICAM-1 in CAD patients were elevated especially in ACS and closely correlated with the activity of disease.Because sICAM-1 was thought to be a marker of inflammation,the results suggested that inflammation was involved in the pathogenesis of CAD.sICAM-1 might be a more sensitive index compared with sVCAM-1 to reflect the disease activity of CAD.