急性心肌梗死患者早期干预过程中血浆P选择素水平的动态变化

目的观察急性心肌梗死(AMI)患者早期干预过程中血浆P选择素、TNF-α以及细胞间黏附分子-1(ICAM-1)水平的动态变化和早期再灌注治疗对其水平的影响。方法AMI患者31例(AMI组),经冠状动脉造影证实的稳定性心绞痛(SAP)患者17例(SAP组),冠状动脉造影正常者19例(对照组)。分别于发病6、12、24、487、2 h抽取静脉血。使用ELISA法测定血浆P选择素、TNF-α及ICAM-1水平。结果AMI组患者发病6 h内P选择素的浓度显著高于SAP组和对照组(P<0.01);12 h P选择素浓度进一步升高;24 h P选择素明显下降,但仍高于SAP组和对照组(P<0.05);48、72 h P选择素浓度与对照组比较无统计学差异。AMI组患者发病6 hTNF-α与ICAM-1即升高,24 h达高峰,72 h后仍高于正常。直线相关分析,AMI患者发病6 h的P选择素与TNF-α、ICAM-1水平呈正相关(r=0.76,P<0.01;r=0.69,P<0.01)。结论早期成功干预治疗使P选择素很快达峰值,然后迅速下降,但对TNF-α和ICAM-1水平变化的影响则不显著。

Changes of P-selectin in patients with acute myocardial infarction during early intervention therapy

Objective To investigate dynamic changes of plasma P-selectin,TNF-α and ICAM-1 in patients with acute myocardial infarction(AMI) and effects of early intervention therapy on them.Methods The plasma P-selectin,TNF-α and ICAM-1 were measured at 6,12,24,48 and 72 h after AMI onset in 31 patients admitted within 6 hours after symptom onset.Seventeen patients with stable angina pectoris(SAP) and 19 normal controls demonstrated by coronary angiography were also measured.Results The level of P-selectin was higher significantly within 6 hours after symptom onset in patients with AMI than that in patients with stable angina and controls(P< 0.01).The level of P-selectin reached peak value at 12 h after symptom onset(4 h after successful reperfusion therapy) in patients with AMI and decreased significantly at 24 h after symptom onset,but still higher than that in SAP patients and controls(P<0.05).There was no difference between the levels of P-selectin at 48 h and 72 h after symptom onset in AMI patients and those in controls.The TNF-α and ICAM-1 increased at 6 h,reached peak values at 24 h,and were still high at 72 h after the symptoms onset in patients with AMI.The levels of P-selectin were positively correlated with those of TNF-α and ICAM-1 at 6 h after symptoms onset in AMI patients(r=0.76,P<0.01;r=0.69,P<0.01).Conclusion Levels of P-selectin reached their peak soon after early intervention therapy and subsequently decreased significantly,but early intervention therapy does not affect TNF-α and ICAM-1.