冠心病介入术后肺部感染对机体hs-CRP与D-二聚体及血管内皮功能的影响

Influence of postoperative pulmonary infection on hs-CRP,D-dimer and vascular endothelial function of percutaneous coronary intervention patients

目的研究冠心病患者在经皮冠状动脉介入术(PCI)治疗后发生肺部感染对机体超敏C-反应蛋白(hsCRP)、D-二聚体及血管内皮功能的影响。方法选取2016年1月-2018年3月进行PCI治疗的冠心病患者作为研究对象,67例术后发生肺部感染的患者作为感染组,80例术后未合并肺部感染的患者作为对照组。比较两组患者术后7天血清中hs-CRP、D-二聚体、一氧化氮(NO)、内皮素-1(ET-1)的含量;比较血流介导的肱动脉内皮依赖性舒张功能(FMD);比较血小板中NO、一氧化氮合成酶(NOS)、L-精氨酸(L-Arg)的水平。结果感染组患者血清中hs-CRP (5.95±2.80)mg/L、D-二聚体(0.59±0.23)mg/L、ET-1(128.56±18.41)ng/L含量均高于对照组(均P<0.05),NO含量(40.91±3.38)μmol/L低于对照组(P<0.05)。感染组患者的FMD(5.83±0.82)%低于对照组(P<0.05)。感染组患者血小板中L-Arg转运量(4.94±1.11)pmol/108pt/min、NOS活性(5.37±1.01)U/108pt/min和NO水平(0.41±0.11)nmol/108pt均低于对照组患者(P<0.05)。结论冠心病患者在PCI治疗后发生的肺部感染可导致机体hs-CRP和D-二聚体显著升高,减弱血管内皮调节功能,可能与感染诱导的血小板L-Arg/NOS/NO信号通路的表达下调有关。

OBJECTIVE To explore the influence of postoperative pulmonary infection on high-sensitivity C-reactive protein(hs-CRP),D-dimer and vascular endothelial function of the coronary heart disease patients undergoing percutaneous coronary intervention(PCI).METHODS The patients with coronary heart disease who were treated with PCI from Jan 2016 to Mar 2018 were recruited as the study objects,67 patients who had postoperative pulmonary infection were assigned as the infection group,and 80 patients who were not complicated with postoperative pulmonary infection were set as the control group.The levels of serum hs-CRP,D-dimer,nitric oxide(NO)and endothelin-1(ET-1)were compared between the two groups of patients after the surgery for 7 days,the endothelium-dependent vasodilatation of the brachial artery was compared,and the levels of NO,nitric oxide synthase(NOS)and L-arginine(L-Arg)in platelets were compared.RESULTS The levels of serum hs-CRP,D-dimer and ET-1 of the infection group were respectively(5.95±2.80)mg/L,(0.59±0.23)mg/L and(128.56±18.41)ng/L,significantly higher than those of the control group(all P<0.05),the NO level of the infection group was(40.91±3.38)μmol/L,significantly lower than that of the control group(P<0.05).The endothelium-dependent vasodilatation of the brachial artery of the infection group was(5.83±0.82)%,significantly lower than that of the control group(P<0.05),The platelet L-Arg transport content,NOS activity and NO level of the infection group were respectively(4.94±1.11)pmol/108 pt/min,(5.37±1.01)U/108 pt/min and(0.41±0.11)nmol/108 pt,significantly lower than those of the control group(P<0.05).CONCLUSION The postoperative pulmonary infection may lead to the significant rise of levels of hs-CRP and D-dimer of the coronary heart disease patients undergoing PCI and weaken the vascular endothelial regulation function,which may be related to the decreased expression of L-Arg/NOS/NO signaling pathway induced by infection.