可溶性粘附分子与冠状动脉支架植入后心脏事件的关系

目的:检测冠心病患者冠状动脉支架植入前的可溶性细胞粘附分子水平,探讨其与以后以发生心脏事件的关系。方法:对2000年4月～2002年3月在我院接受冠状动脉支架植入的107例患者,以ELISA法检测支架植入前基础血浆可溶性粘附分子水平,并进行随访。结果:20例患者失访,随访率81.3％,随访时间3～24(平均17.4)月。随访期间心绞痛症状复发13例(14.9％),非致命性心梗2例(2.3％),猝死1(1.1％)。发生心脏事件组基础可溶性细胞间粘附分子-1(sICAM-1)水平较无心脏事件组升高(P<0.01),而可溶性血管细胞粘附分子-1(sVCAM-1)、可溶性E选择素(sE-selectin)水平在两组间无显著性差异(P>0.05)。以Kaplan-Meier法计算无心脏事件生存率,slCAM-1≥276ng/ml组2年无心脏事件生存率为67.8％,而sICAM-1<276ng/ml组为88.4％,两组间有显著性差异(P<0.01)。结论:冠状动脉支架植入前基础血浆sICAM-1水平升高的患者术后无心脏事件生存率低,sICAM-1可作为冠状动脉支架植入后心脏事件发生的预测指标。

Relationship between baseline plasma concentration of soluble cell adhesion molecules and subsequent cardiac events after coronary stent

Objective: To evaluate whether soluble cell adhesion molecules (sCAM) are markers for subsequent cardiac events after coronary stent. Methods: Baseline plasma level of sCAM were measured from 107 patients with coronary heart disease. All patients underwent stent implantation and followed up. The follow-up period was 3-24 months and the follow-up rate was 81. 3%. All cardiac events were recorded. Results: During follow-up period, 13 cases had recurrent angina, 3 cases had non-fatal acute myocardial infarction and 1 patient suffered sudden death. Baseline concentration of soluble intercelluar adhesion molecule-1 (sICAM-1) in cardiac events group was higher than that in no-cardiac events group (P<0. 01) .The cardiac event-free survival rate calculated by Kaplan-Meier method in sICAM-1 3i276ng/ml group was 67.8% in 2 years while that in sICAM-K276ng/ml group was 88.14% (P< 0. 01). Conclusion; Patients with higher baseline level of sICAM-1 may have lower cardiac event-free survival rate after coronary stent implantation and baseline level of sICAM-1 may have prognostic value.