冠心病患者P-选择素水平及其与冠状动脉病变程度间的关系

目的观察冠心病不同类型患者中P选择素水平的变化及其与冠状动脉粥样硬化狭窄程度的数量关系,探讨急性冠状动脉综合征临床识别和预测的炎症指标。方法应用酶联免疫吸附法检测血浆可溶性P选择素水平,对冠状动脉粥样硬化病变程度按照病变支数、Gensini评分和ACC/AHA冠状动脉病变A、B、C分型进行数量评估。结果①冠心病组P选择素水平高于正常对照组(180.6ng/L±60.5ng/Lvs.145.3ng/L±21.7ng/L,P<0.05);②急性冠状动脉综合征组P选择素水平高于稳定型心绞痛组(191.4ng/L±63.7ng/Lvs.141.3ng/L±17.9ng/L,P<0.01);③冠状动脉多支病变组P选择素水平高于单支病变组(190.1ng/L±64.2ng/Lvs.157.2ng/L±43.4ng/L,P<0.05)。P选择素水平与冠状动脉病变数量呈Spearman正相关(rs=0.349,P=0.003);与A、B、C型冠状动脉病变程度呈Spearman正相关(rs=0.358,P=0.002);与Gensini法评分呈线性正相关(r=0.391,P=0.001)。结论①细胞黏附分子P选择素水平受冠状动脉粥样硬化程度、数量的影响,与冠状动脉粥样硬化狭窄病变程度和数量呈正相关。②P选择素水平与急性冠状动脉综合征的发生有关,是急性冠状动脉综合征临床识别和预测的炎症指标。

The study of soluble P-selectin levels and it'scorrelation to the severity of coronary artery lesions in coronary heart disease

OBJECTIVE: To investigate the difference of soluble P-selectin levels in different subtype of coronary heart disease and the relationship between soluble P-selectin levels with the severity of coronary artery lesions. METHODS: Enzyme linked immuoserbent assay (ELISA) was used to measure the plasma soluble P-selectin levels in 69 patients with angiocardiography documented coronary heart disease and 19 normal coronary arteries persons without angiocardiography detectable coronary artery disease (control group). The coronary artery lesions score was recorded according to single, double and triple-vessel lesions while the American College of Cardiology and the American Heart Association proposed type A, B, C lesion and Gensini scoring system. The relationships between plasma soluble P-selectin levels and the coronary artery score (the severity of coronary heart disease) were assessed. RESULTS: (1) The level of plasma soluble P-selectin was obviously higher in the coronary heart disease group than in the control group (180.6 +/- 60.5 ng/L vs. 145.3 +/- 21.7 ng/L, P<0.05). (2) The level of plasma soluble P-selectin was significantly higher in the acute coronary syndrome group (191.4 +/- 63.7 ng/L) than in the control group (145.3 +/- 21.7 ng/L, P< 0.01) and in the stable angina pectoris group (141.3 +/- 17.9 ng/L, P<0.01). (3) The level of plasma soluble P-selectin was high in multi-vessel coronary artery lesions group than in single-vessel group (190.1 +/- 64.2 ng/L vs. 157.2 +/- 43.4 ng/L, P < 0.05). The level of plasma soluble P-selectin was positively correlated with the Gensini score (r = 0.391, P = 0.001); the numbers of vessels lesions (rs = 0.349, P = 0.003); Type A, B and C lesions (rs = 0.358, P = 0.002). CONCLUSION: The positive correlation between the level of soluble P-selectin and the coronary artery score may indicate that soluble P-selectin levels might reflect the severity of coronary heart disease. The elevated soluble P-selectin level in acute coronary syndrome suggested the possible relation of P-selectin to the pathogenesis of acute coronary syndrome, which may save as a potential marker of plaque unstability.