感染性心内膜炎术后可溶性细胞间黏附分子1、可溶性P-选择素和凝血功能的表达及其临床意义

目的探讨细菌性感染性心内膜炎(infectious endocarditis,IE)术后辅助性T细胞17(T helper cell 17,Th17)相关因子、可溶性细胞间黏附分子1(soluble intercellular adhesion molecule-1,sICAM-1)、凝血功能的表达及其意义。方法选取2016年12月至2018年12月首都医科大学附属北京安贞医院心脏外科手术治疗且符合纳入标准的IE患者进行前瞻性分析,38例IE患者作为观察组;选取同期健康体检者30名为对照组。采用双抗夹心酶联免疫吸附(enzyme-linked immunosorbent assay,ELISA)法测定两组血清Th17相关因子[白细胞介素1β(interleukin-1β,IL-1β)、白细胞介素6(interleukin-6,IL-6)、白细胞介素17(interleukin-17,IL-17)及白细胞介素21(interleukin-21,IL-21)]、sICAM-1及凝血功能指标[可溶性P-选择素(P selectin,sP-SLT)]浓度,并对两组间相关指标的浓度差异进行统计学分析比较。结果观察组患者术前血清IL-1β、IL-6、IL-17及IL-21浓度[(29.88±6.49)、(14.89±3.31)、(21.89±3.01)、(563.26±67.36)ng/L]显著高于对照组[(16.56±4.11)、(7.52±2.34)、(12.91±1.01)、(423.38±56.49)ng/L],差异有统计学意义(t值分别为10.30、10.74、17.20、49.48,P均<0.05)。观察组术前血清sICAM-1、sP-SLT浓度[(1247.57(581.39,1794.66)μg/L、(60.29±6.61)mg/L]显著高于对照组[(837.28(405.68,954.47)μg/L、(27.37±5.56)mg/L],差异有统计学意义(Z=12.37、t=22.30,P均<0.05)。术后感染性心内膜炎患者血清IL-1β、IL-6、IL-17及IL-21浓度[(16.19±4.07)、(7.73±2.40)、(13.83±0.94)、(425.33±52.12)ng/L]较术前[(29.88±6.49)、(14.89±2.31)、(21.89±3.01)、(563.26±67.36)ng/L]均显著降低,差异有统计学意义(t值分别为11.02、13.25、15.76、9.98,P均<0.05)。术后感染性心内膜炎患者血清sICAM-1、sP-SLT1浓度[(901.46(472.15,1276.58)μg/L、(30.70±5.31)mg/L]较术前[(1057.26±463.06)μg/L、(60.29±6.61)mg/L]显著降低,差异有统计学意义(Z=11.16、t=21.51,P均<0.05)。结论在IE患者中Th17相关因子、sICAM-1及sP-SLT呈高浓度表达,同时术后上述因子浓度降低,提示以上因子可能作为辅助诊断、评估IE患者病情及预后的相关因子。

Expression and clinical significance of soluble intercellular adhesion molecule 1, soluble P-selectin and coagulation function in patients with infective endocarditis

Objective To investigate the expression and significance of T helper cell 17(Th17),soluble intercellular adhesion molecule-1(sICAM-1)and coagulation function in patients with infectious endocarditis(IE).Methods From December 2016 to December 2018,IE patients in Beijing Anzhen Hospital Affiliated to Capital Medical University who met the inclusion criteria were selected for cardiac surgery to analyze prospectively,38 IE patients were selected as the observation group,and 30 healthy people were selected as the control group.The concentrations of serum Th17 related factors(IL-1β,IL-6,IL-17 and IL-21),sICAM-1 and coagulation index(P selectin(sP-SLT))were measured by enzyme-linked immunosorbent assay(ELISA)and the difference between the two groups were statistically analyzed.Results The concentrations of serum IL-1β,IL-6,IL-17 and IL-21((29.88±6.49),(14.89±3.31),(21.89±3.01),(563.26±67.36)ng/L)in the observation group were significantly higher than those in the control group((16.56±4.11),(7.52±2.34),(12.91±1.01),(423.38±56.49)ng/L)(all P<0.05).The level of serum sICAM-1 and sP-SLT((1247.57(581.39,1794.66)μg/L,(60.29±6.61)mg/L)in the observation group were significantly higher than those in the control group((837.28(405.68,954.47)μg/L,(27.37±5.56)mg/L),and the difference was statistically significant(Z=12.37,t=22.30,all P<0.05).The level of serum IL-1β,IL-6,IL-17 and IL-21 in patients with postoperative infective endocarditis((16.19±4.07),(7.73±2.40),(13.83±0.94),(425.33±52.12)ng/L)were significantly lower than those before operation((29.88±6.49),(14.89±2.31),(21.89±3.01),(563.26±67.36)ng/L),and the differences were statistically significant(t values were 11.02,13.25,15.76,9.98,all P<0.05).The levels of sICAM-1 and sP-SLT1 in patients with postoperative infective endocarditis((901.46(472.15,1276.58)μg/L,(30.70±5.31)mg/L)were significantly lower than those before operation((1057.26±463.06)μg/L,(60.29±6.61)mg/L)and the differences were statistically significant(Z=11.16,t=21.51,P<0.05).Conclusion Th17 related factors,sICAM-1 and sP-SLT were highly expressed in IE patients,and the concentrations of these factors decreased after operation,suggesting that the above factors may be used as related factors for the diagnosis and prognosis of IE patients.