循环内皮脂酶阳性细胞比例与超敏C-反应蛋白在冠心病患者临床预后中的作用

目的随访检测冠心病患者内皮脂酶阳性的循环内皮细胞比例（EL＋/CECs）和超敏C-反应蛋白（hsCRP）6个月以上,探讨二者在临床预后中的作用。方法107例急性冠脉综合征（ACS）患者和69例稳定型心绞痛（SAP）患者,经冠状动脉（冠脉）造影证实有明显冠脉狭窄;经临床检查和选择性冠脉造影选择82例对照组患者。采集肘静脉血液标本,检测hsCRP,分离循环内皮细胞（CEC）,以免疫组化法检测CEC中EL的表达,并计算EL＋/CECs。所有患者进行6个月以上随访,记录心脏事件（反复心绞痛发作、非致死性心肌梗死、心源性死亡）,分析hsCRP、EL＋/CECs与心脏事件发生的关系。结果3组患者一般情况差异无统计学意义;hsCRP、EL＋/CECs差异有统计学意义（P〈0.05或P〈0.01）,其中以ACS组值最大,对照组值最小。所有研究对象随访结果发现,与低于hsCRP或EL＋/CECs均值（hsCRP为2.64mg/L,EL＋/CECs为25.27）的患者比较,高于均值的患者心脏事件的发生率显著增高（P均〈0.01）。回归分析发现,hsCRP与EL＋/CECs均可作为心脏复合事件的预测因子,二者结合起来,可显著提高预测价值。结论冠心病患者血管内皮细胞表达的EL可能参与了冠心病发病,EL＋/CECs可作为冠心病临床预后的预测因子,联合使用EL＋/CECs与hsCRP可显著提高冠心病患者预后的预测效率。

Significance of the ratio of circulating endothelial cell expressing endothelial lipase and supersensitivity C - reactive protein in prognosis of patients with coronary artery disease

OBJECTIVE: To evaluate the significance of the ratio of circulating endothelial cell expressing endothelial lipase (EL(+)/CECs) and supersensitivity C-reactive protein (hsCRP) in prognosis of patients with coronary artery disease (CAD). METHODS: one hundred and seven patients with acute coronary syndrome (ACS), 69 patients with stable angina pain (SAP), and 82 patients in whom CAD was excluded to serve as control were included for study. Blood samples were collected from ulnar wein, and hsCRP was detected, circulating endothelial cells (CECs) were isolated, and the ratio of CEC (EL(+)/CECs) which expressed endothelial lipase (EL) was determined by immmunohis to chemistry. Over a follow-up period of 6 months, the incidence of cardiac event of all patients was recorded. RESULTS: In patients with CAD, the EL(+)/CECs and hsCRP were significantly different among groups (P<0.05 or P<0.01). Among them, hsCRP and EL(+)/CECs were higher in ACS group than SAP group patients, whose hsCRP and EL(+)/CECs higher than the control group. The incidence rate of cardiovascular event was significantly higher (all P<0.01) in those whose hsCRP or EL(+)/CECs was higher than those whose with lower average values of these two parameters. Regression analysis indicated that the EL(+)/CECs and hsCRP could be used as the prognostic factor of CAD. The prognostic value of combined determination of EL(+)/CECs and hsCRP was higher. CONCLUSION: The expression of EL in endothelial cells may play a role in the progression of CAD. The EL(+)/CECs may be a good prognostic factor. EL(+)/CECs together with hsCRP may increase the prognostic value.