摘要
目的观察不稳定性心绞痛和急性心肌梗死患者血清P选择素的动态变化,探讨黏附分子与急性冠脉综合征(ACS)诊断及再灌注治疗效果的关系及临床意义。方法取43例ACS患者末梢血,包括18例不稳定心绞痛(UA)和25例急性心肌梗死(AMI),15例稳定心绞痛(SA)和15例健康者,各组性别、年龄、血脂和血糖水平差异无统计学意义,具有可比性。所有ACS患者经溶栓治疗后冠脉再通15例,未通10例。采用酶联免疫吸附法(ELISA)检测治疗前和后3 h、6 h、12 h血清P选择素水平。结果SA患者P选择素为(11.9±3.7)ng/ml,与正常对照组比较差异无统计学意义[(9.6±4.9)ng/ml,t=1.83,P>0.05]。UA组与AMI组P选择素为(25.7±15.3)和(44.3±19.1)ng/ml,均显著高于正常对照组(t=3.88和3.21,P<0.01),且AMI组显著高于UA组(t=3.49,P<0.01)。溶栓3 h P选择素水平冠脉再通组为(66.5±14.8)ng/ml,显著高于未通组[(50.3±10.6)ng/ml,t=2.98,P<0.01]。再通组溶栓后6 h P选择素开始下降,12 h降至正常水平,而未通组呈持续增高。再通组CK-MB溶栓12 h后达高峰值(928.4±86.8)!mol/L,未通组溶栓20 h后达高峰值(986.4±91.7)!mol/L。结论P选择素变化水平与急性冠脉综合征严重程度及急性心肌梗死静脉溶栓后血管再通程度有关。检测P选择素的动态变化有助于对急性冠脉综合征严重程度的识别,也可作为急性心肌梗死静脉溶栓治疗是否成功的间接观察指标之一。
Object： ve To investigate the dynamic changes of serum P-selectin in different types of acute coronary syndrome （ACS） and clinical values thereof. Methods Peripheral blood samples were collected from 43 patients with ACS, including 18 cases of unstable angina pectoris （UA） and 25 cases of acute myocardiac infarction （AMI）, 15 stable angina （SA）, and 15 healthy persons, all sex, age, blood lipid, and blood glucose-matched. All patients underwent thrombolysis therapy, coronary artery recanalization was achieved in 15 patients and failed to be achieved in 10 patients. ELISA was used to measure the serum P-selectin before and 3, 6, and 12 hours after the treatment. Results The P-selectin of the SA patients was （11.9±3.7）ng/ml, not significantly different from that of the normal controls [（9.6_±4.9 ）ng/ml, t= 1.83, P 〉0.05]. The P-selectin of the UA and AMI patients were （25.7±15.3） and（44.3±19.1 ）ng/ml respectively, both significantly higher than that of the normal control group （t= 3.88 and 3.21 ,both P〈0.01）, and the P-selectin level of the AMI patients was significantly higher than that of the UA group （t=3.49,P〈0.01）.The P-selectin level 3 hours after thrombolysis of the coronary artery recanalization group was（66.5±14.8）ng/ml, significantly higher than that of the noncoronary artery recanalization group [ （50.3± 10.6 ）ng/ml, t= 2.98, P 〈 0.01 ]. The P-selectin level of the coronary artery recanalization group began to decrease 6 h after thrombolysis and dropped to the normal level 12 h after thrombolysis, however, the P-selectin level of the non-coronary recanalization group continued to increase. The CK-MB level of the recanalization group peaked to （928.4±86.8）μmol/L 12 h after thrombolysis, and the CK-MB level of the non-recanalization group peaked to （986.4±91.7）μmol/L 12 h after thrombolysis. Conclusion The serum P-selectin level is related to the severity of ACS and to the recanalization degree of the obstructed vessels after throm
出处
《中国急救复苏与灾害医学杂志》
2008年第3期141-144,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
P选择素
急性冠脉综合征
静脉溶栓
缺血再灌注损伤
肌酸激酶同功酶
P-selectin
Acute coronary syndrome
Intravenous thrombolysis
Ischemia reperfusion injury
Creatinine kinase-MB
