Abstract
目的 探讨7种外周血循环标志物在不同类型冠心病患者中的临床应用价值.方法 对190例可疑冠心病患者,行选择性冠状动脉造影术,确定只少一支冠状动脉直径狭窄≥50%为冠状动脉造影阳性,其中冠状动脉造影阳性组144例,包括稳定性心绞痛(SAP)患者62例,ACS患者82例;冠状动脉造影阴性组46例.应用流式细胞术进行患者血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、sCD40L、单核细胞趋化蛋白-1(MCP-1)、可溶性P-选择素(P-selectin)、组织纤溶酶原激活剂(t-PA)、可溶性血管细胞黏附分子(sVCAM-1)的测定.结果 急性冠状动脉综合征组血清sCD40L水平(8.6±5.1)ng/L较稳定性心绞痛组(5.7±4.4)ng/L和冠状动脉造影阴性组(4.1±3.3)ng/L明显升高(P＜0.01),其余标志物在各组间均有统计学意义(P＜0.01).Logistic回归分析显示,冠脉造影阳性组和阴性组,OR值最大的是sCD40L(OR=1.41,95%CI 1.08～1.85);而在稳定性心绞痛组和急性冠脉综合征组间,OR值最大的是sP-selectin(OR=1.06,95%CI 1.02～1.10),而IL-6在两种分组中,也有统计学意义.结论 IL-6、sCD40L和sP-selectin作为冠心病严重程度的估计和监测可能优于其他几种标志物,同时也为进一步解释急性冠状动脉综合征患者斑块不稳定性的病理生理学机制提供有用的佐证。
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