血管细胞黏附分子-1在检测慢性阻塞性肺疾病中的临床意义

目的 探讨可溶性血管细胞黏附分子-1(sVCAM-1)和可溶性血小板内皮细胞黏附分子-1(sPECAM-1)在COPD发病中的作用.方法 病例为2005年12月至2006年3月在遵义医学院附属医院呼吸科住院患者.采用酶联免疫吸附测定法,检测20例健康成人(对照组)和35例COPD急性加重期(AECOPD)患者治疗前后血浆D-二聚体、sVCAM-1和sPECAM-1水平.统计学处理采用t检验和Pearson直线相关分析.结果 AECOPD治疗前组D-二聚体(4.49±1.47)mg/L]明显高于治疗后组(1.98±0.92)mg/L]和对照组(0.44±0.14)mg/L],治疗后组也明显高于对照组;治疗前组sVCAM-11(11±5)nmol/L]明显高于治疗后组(8±4)nmol/L]和对照组(7±4)nmol/L];治疗后组sPECAM-1(61±13)pmol/L]明显高于治疗前组(36±8)pmol/L]和对照组(43±10)pmol/L],对照组也明显高于治疗前组;治疗前sVCAM-1与D-二聚体呈正相关(r=0.759,P＜0.01),治疗前sPECAM-1与D-二聚体、sVCAM-1均无直线相关性(r值分别为0.045和0.078,P均＞0.05);治疗后sPECAM-1与D-二聚体呈负相关(r=-0.548,P＜0.01),治疗后sVCAM-1与D-二聚体、sPECAM-1均无直线相关性(r值分别为-0.032、0.143,P均＞0.05);对照组D-二聚体、sVCAM-1及sPECAM-1三者之间均无直线相关性(r值分别为0.137、-0.121和0.035,P均＞0.05).结论 D-二聚体、sVCAM-1在AECOPD显著增高,表明AECOPD存在血栓前状态,提示D-二聚体和sVCAM-1可作为判断AECOPD并发血栓前状态及其严重程度的指标;sPECAM-1在治疗后显著增高,可能作为一种保护性因子起对抗血栓前状态的作用.

Detection and clinical significance of vascular cell adhesion molecules-1 in chronic obstructive pulmonary disease

OBJECTIVE: To explore the role of soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble platelet endothelial cell adhesion molecular-1 (sPECAM-1) of prethrombotic state mediators in patients with chronic obstructive pulmonary disease (COPD). METHODS: The blood plasma levels of D-dimer (D-D), sVCAM-1 and sPECAM-1 in 20 healthy volunteers (control group) and 35 patients with acute exacerbation of COPD ( AECOPD) before and after treatment were measured by ELISA. The statistical analysis used Student' s t test of significance and Pearson linear correlation analysis. RESULTS: The level of D-D in patients before treatment (4.49 +/- 1.47) mg/L] was significantly higher than that after treatment (1.98 +/- 0.92) mg/L] and that of the control group (0.44 +/- 0.14) mg/L] (t = 0.91, 13.10, both P < 0.001); the level of D-D in patients after treatment was also higher than that of the control group (t = 4.96, P < 0.001). The level of sVCAM-1 in patients before treatment (11 +/- 5) nmol/L] was significantly higher than those of patients after treatment (8 +/- 4) nmol/L] and control group (7 +/- 4) nmol/L] (t = 2. 24, 2.75, both P < 0.001); but the difference of sVCAM-l between the post-treatment group and the control group was not significant (t = 0.75, P > 0.05). The level of sPECAM-1 in patients after treatment (61 +/- 13) pmol/L] was significantly higher than that before treatment (36 +/- 8) pmol/L] and that of the control group (43 +/- 10) pmol/L] (t = 9.23, 5.91, both P < 0.001), and the level of the control group was also higher than that of patients before treatment (t = 2.35, P < 0.05). Before treatment, there was significant positive correlation between D-D and sVCAM-1 (r = 0.759, P < 0.01) but no correlation between sPECAM-1 and D-D or sVCAM-1 (r = 0.045, 0.078, both P > 0.05). After treatment, there was significant negative correlation between D-D and sPECAM-1 (r = -0.548, P < 0.01) but no correlation between sVCAM-land D-D or sPECAM-1 (r = -0.032, 0.143, both P > 0.05). There were no correlations among D-D and sPECAM-1 and sVCAM-1 respectively in the control group (r = 0.137, -0.121, 0.035, all P > 0.05). CONCLUSIONS: The levels of D-D and sVCAM-1 increase significantly during acute exacerbation of COPD, which suggests that prethrombotic state exists in acute exacerbation of COPD. The measurement of D-D and sVCAM-1 is useful to monitor prethrombotic state during acute exacerbation of COPD and may be useful in evaluating the severity. The significant increase of sPECAM-1 in plasma of patients after treatment suggests that sPECAM-1 may be a protective factor against prethrombotic state.