老年冠状动脉粥样硬化性心脏病患者冠状动脉病变影响因素的探讨

目的探讨循环人血管紧张素1～7(Ang1～7)、内皮细胞微颗粒CD31^＋、单核细胞CD14^＋CD16^＋和超敏C－反应蛋白(hs－CRP)对老年冠状动脉粥样硬化性心脏病患者冠状动脉病变的影响。 方法选择2010年1月至2014年3月老年冠状动脉粥样硬化性心脏病患者140例，健康对照组50例。根据冠状动脉狭窄程度将患者分为3组：75%～84%组，85%～94%组和95%～100%组；根据冠状动脉病变支数将患者分为4组：单支、双支、三支和四支病变组；再根据美国纽约心脏病学会(NYHA)分级将患者分为4组：NYHAⅠ、Ⅱ、Ⅲ、Ⅳ级组；又根据左心室射血分数(LVEF)进一步将患者分为3组：48%～58%组、36%～47%组和25%～35%组；根据6 min步行试验的步行距离又将患者分为3组：>450 m组、150～450 m组和<150 m组。采用流式细胞术检测血清CD31^＋和CD14^＋CD16^＋水平的变化，使用双夹心抗体酶联免疫吸附法定量检测Ang1～7水平，应用免疫散射比浊法测定hs－CRP的水平。多组间差异采用单因素方差分析，组间两两比较采用t检验。 结果冠状动脉狭窄75%～84%组Ang1～7(34.8±6.9)pg/mL、CD31^＋(471±29)个/μL、CD14^＋CD16^＋(1.4±0.3)%、hs－CRP(1.7±0.8)mg/L分别与冠状动脉狭窄95%～100%组Ang1～7(9.1±0.4) pg/mL、CD31^＋ (1554±40)个/μL、CD14^＋CD16^＋(5.9±0.8)%、hs－CRP(17.1±1.5) mg/L比较，差异均有统计学意义(P值均小于0.05)；冠状动脉单支病变组Ang1～7(38.7±7.9)pg/mL、CD31^＋(496±30)个/μL、CD14^＋CD16^＋(2.1±0.7)%、hs－CRP(1.9±0.9)mg/L与分别冠状动脉四支病变组Ang1～7(11.2±2.0)pg/mL、CD31^＋(1583±52)个/μL、CD14^＋CD16^＋(10.6±1.4)%、hs－CRP(14.9±1.9)mg/L比较，差异均有统计学意义(P值均小于0.05)；NYHAⅠ级组Ang1～7(38.5±2.7)pg/mL、CD31^＋(511±32)个/μL、CD14^＋CD16^＋(1.7±0.5)%、hs－CRP(1.9±0.2)mg/L与分别NYHA Ⅳ级组Ang1～7(10.0±1.2)pg/mL、CD31^＋(1598±49)个/μL、CD14^＋CD16^＋(12.1±1.4)%、hs－CRP(15.0±1.9)mg/L比较，差异均有统计学意义(P值均小于0.05)；LVEF 48%～58%组Ang1～7(32.9±6.8)pg/mL、CD31^＋(385±28)个/μL、CD14^＋CD16^＋(2.9±0.8)%、hs－CRP(2.1±0.8)mg/L与分别LVEF 25%～35%组Ang1～7(9.5±2.0)pg/mL、CD31^＋(1644±54)个/μL、CD14^＋CD16^＋(13.0±1.6)%、hs－CRP(14.1±2.0)mg/L比较，差异均有统计学意义(P值均小于0.05)；6 min步行试验>450 m组Ang1～7(36.4±7.1)pg/mL、CD31^＋(561±30)个/μL、CD14^＋CD16^＋(1.9±0.5)%、hs－CRP(2.1±0.9)mg/L与分别6 min步行试验<150 m组Ang1～7(10.1±0.9)pg/mL、CD31^＋(1338±41)个/μL、CD14^＋CD16^＋(7.2±0.9)%、hs－CRP(18.7±1.5)mg/L比较，差异均有统计学意义(P值均小于0.05)。 结论Ang1～7水平下降，CD31^＋、CD14^＋CD16^＋和hs－CRP表达水平的增高可能影响老年冠状动脉病变的严重程度。

Disscussion on influencing factors of coronary artery disease in elderly patients with coronary atherosclerotic heart disease

ObjectiveTo study the effects of circulation human angiotensin 1-7 (Ang1-7)、CD31⁺ 、CD14⁺ CD16⁺ and hypersensitive C-reactive protein(hs-CRP) on coronary artery lesions in elderly patients with coronary artery disease. MethodsOne hundred and forty elderly patients with coronary artery disease were enrolled during the time period from January 2010 to March 2014 , 50 healthy persons were selected as the control group. According to the degree of coronary artery stenosis, the patients were divided into 3 groups: 75% to 84% group, 85% to 94% group and 95% to 100% group. According to the number of diseased coronary arteries, the patients were divided into 4 groups: single vessel lesion group, double vessel lesion group, three branch lesion group and four vessel disease group. According to the New York Heart Association (NYHA) classification, the patients were divided into 4 groups: NYHA Ⅰ group, NYHA Ⅱ group, NYHA Ⅲ group and NYHA Ⅳ group. According to the left ventricular ejection fraction (LVEF), the patients were divided into 3 groups: 48% to 58% group, 36% to 47% group and 25% to 35% group. According to the six-minute-walking-test, the patients were divided into 3 groups: >450 m group, 150-450 m group and<150 m group. Flow cytometry were used to detect the changes of serum CD31⁺ and CD14⁺ CD16⁺ levels. Double antibody sandwich enzyme-linked immunosorbent assay was used to quantitatively detect the levels of Ang1-7.The levels of hs-CRP were measured by immune scatter turbidity method. Multi group differences were analyzed by single factor analysis of variance, and t test was used to compare between the two groups. ResultsPatients with coronary artery stenosis showed Ang1-7(34.8±6.9)pg/mL, CD31⁺ (471±29)/μL, CD14⁺ CD16⁺ (1.4±0.3)%, hs-CRP(1.7±0.8)mg/L in 75%-84% group vs Ang1-7 (9.1±0.4)pg/mL, CD31⁺ (1554±40)/μL, CD14⁺ CD16⁺ (5.9±0.8)%, hs-CRP (7.1±1.5)mg/L in 95%-100%group, the differences were statistically significant, all P values were less than 0.05. Ang1-7(38.7±7.9)pg/mL, CD31⁺ (496±30)/μL, CD14⁺ CD16⁺ (2.1±0.7)%, hs-CRP(1.9±0.9)mg/L in single vessel lesion group vs Ang1-7(11.2±2.0)pg/mL, CD31⁺ (1583±52)/μL, CD14⁺ CD16⁺ (10.6±1.4)%, hs-CRP(14.9±1.9)mg/L in four vessel disease group, the differences were statistically significant, all P values were less than 0.05. NYHAⅠ group Ang1-7(38.5±2.7)pg/mL、CD31⁺ (511±32)/μL、CD14⁺ CD16⁺ (1.7±0.5)%、hs-CRP(1.9±0.2)mg/L vs NYHA Ⅳgroup Ang1-7(10.0±1.2)pg/mL、CD31⁺ (1598±49)/μL、CD14⁺ CD16⁺ (12.1±1.4)%、hs-CRP(15.0±1.9)mg/L, the differences were statistically significant, all P values were less than 0.05; LVEF 48%-58% group Ang1-7(32.9±6.8)pg/mL、CD31⁺ (385±28)/μL、CD14⁺ CD16⁺ (2.9±0.8)%、hs-CRP(2.1±0.8)mg/L vs LVEF 25%-35% group Ang1-7(9.5±2.0)pg/mL、CD31⁺ (1644±54)/μL、CD14⁺ CD16⁺ (13.0±1.6)%、hs-CRP(14.1±2.0)mg/L, the differences were statistically significant, all P values were less than 0.05; 6 min walk test Ang1-7(36.4±7.1)pg/mL、CD31⁺ (561±30)/μL、CD14⁺ CD16⁺ (1.9±0.5)%、hs-CRP(2.1±0.9)mg/L in >450 m group vs Ang1-7(10.1±0.9)pg/mL、CD31⁺ (1338±41)/μL、CD14⁺ CD16⁺ (7.2±0.9)%、hs-CRP(18.7±1.5)mg/L in <150 m group, the differences were statistically significant, all P values were less than 0.05. ConclusionsThe decrease in the level of Ang 1-7 and increase in the levels of CD31⁺ 、CD14⁺ CD16⁺ and hs-CRP maybe affect the degree of coronary artery stenosis in elderly patients with coronary artery disease.