高敏C反应蛋白、丙二醛及P选择素在冠心病患者中的变化及相互关系

摘要

目的 探讨炎症、氧化应激及血小板在冠心病患者中的变化及相互间关系.方法 入选冠心痛患者67例,稳定型心绞痛组(SAP组)14例,不稳定型心绞痛组(UAP组)25例,急性心肌梗死组(AMI组)28例.另选取健康者20例作为对照组.分别应用免疫比浊法、比色法和酶联免疫吸附法检测血清高敏C反应蛋白(hsCRP)、血浆丙二醛(MDA)及P选择素浓度.结果 hsCRP水平在SAP组、UAP组、AMI组均高于对照组,(1.57±1.15)mg/L,(3.80±3.39) mg/L,(9.61±4.22)mg/Lvs (0.84±0.16)mg/L,除SAP组与对照组比较差异无统计学意义外,其他3组间差异均有统计学意义(P＜0.01).MDA浓度在SAP组、UAP组、AMI组均高于对照组,(9.66±2.08)μmol/L(13.31±3.01) μmol/L,(15.44±4.55) μmol/L vs(7.11±4.67)μmol/L,除SAP组与对照组比较差异无统计学意义外,其他3组间差异均有统计学意义(P＜0.01).P选择素水平在SAP组、UAP组、AMI组均高于对照组,(117.84±51.86)μg/L,(160.61±59.36) μg/L,(168.82±60.84) μg/L vs (92.91±44.74) μg/L,除SAP组与对照组比较差异无统计学意义外,其他3组间差异均有统计学意义(P＜0.01).hsCRP与P选择素呈正相关(r=0.603,P＜0.01);MDA与P选择素呈正相关(r=0.693,P＜0.01)；hsCRP与MDA呈正相关(r=0.667,P＜0.01).结论 冠心病患者hsCRP、MDA及P选择素浓度从SAP组到UAP和AMI组逐渐升高,且呈正相关,提示三者间相互作用决定斑块稳定型及临床表现.%Objective To investigate the changes of inflammation,oxidative stress and platelets in patients with coronary heart disease(CHD) and their relationship. Methods Sixty-seven CHD patients were selected, including 14 patients with stable angina pectoris(SAP group) ,25 patients with unstable angina pectorisCUAP group) and 28 patients with acute myocardial infarction( AMI group). 20 healthy subjects were selected as controls. The serum high sensitive C-reactive protein (hsCRP) , plasma malondialdehyde ( MDA) and P-selectin levels were measured respectively with immunoturbidimetry, chromatometry and enzyme-linked immunosorbent assay, their relationships were analyzed. Results The level of hsCRP of SAP group, UAP group and AMI group were markedly higher than that of control group,(1. 57±1. 15) mg/L,(3. 80 ± 3. 39) mg/L,(9. 61 ± 4. 22) mg/L vs (0.84 ± 0.16) mg/L,there were significant difference between other three groups ( P <0. 01) except between control and SAP group. The concentration of MDA of SAP group,UAP group and AMI group were higher than that of control group, (9. 66 ± 2. 08) μmol/L,(13. 31 ± 3. 01) μmol/L,(15. 44±4. 55) μmol/L vs (7. 11 ± 4. 67) μmol/L,there were significant difference between other three groups ( P <0. 01) except between control and SAP group. The concentration of P-selectin of SAP group,UAP group and AMI group were higher than that of control group, (117. 84 ±51. 86) μ/g/L,(160. 61 ± 59. 36) μg/L,(168. 82 ± 60. 84) μg/L vs (92. 91±.44. 74) μg/L,there were significant difference between other three groups ( P<0. 01) except between control and SAP group. There were positive correlations between P-selectin and hsCRP ( r = 0. 603, P < 0. 01) and MDA ( r =0. 693, P <0. 01),also between hsCRP and MDA ( r =0. 667, P <0. 01). Conclusion The concentrations of hsCRP,MDA and P-selectin in patients with CHD increase gradually from SAP to UAP and AMI group,and there are positive correlations among them. This indicates there are interactions among inflammation, oxidative stress and platelet activation,all of them determine the plaque stability and clinical manifestation.