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冠心病病人血清sgp130与hsCRP变化及其意义

时间:2006-11-26栏目:基础医学论文

  冠心病病人血清sgp130与hsCRP变化及其意义
  
  作者:逄帅 吕文辉 李大鹏 刘成玉
  
  【摘要】  目的 探讨冠心病(CHD)病人血清可溶性糖蛋白130(sgp130)和超敏C反应蛋白(hsCRP)的变化及其临床意义。方法 采用ELISA和散射速率比浊法检测了20例急性心肌梗死(AMI)病人、20例不稳定型心绞痛(UAP)病人、20例稳定型心绞痛(SAP)病人血清sgp130、hsCRP水平的变化,并与20例健康体检者(对照组)进行比较。结果 CHD病人血清sgp130水平明显降低,血清hsCRP水平明显增高,与对照组比较,差异有显著性(t=6.97、6.86,P<0.01)。AMI、UAP及SAP病人sgp130和hsCRP水平比较,差异有显著性(F=47.14、36.23,q=4.26-15.66,P<0.01)。AMI病人血清sgp130、hsCRP水平均低于或高于UAP病人、SAP病人和对照组(q=4.59-15.66,P<0.01);UAP病人血清sgp130、hsCRP水平显著低于或高于SAP病人和对照组(q=4.26-11.06,P<0.01);SAP病人血清sgp130水平与对照组之间亦有统计学差异(q=4.93,P<0.01)。CHD病人血清sgp130与hsCRP水平呈负相关(r=-0.574,P<0.01)。血清sgp130、hsCRP水平在AMI、UAP组AUCROC均大于0.90,对AMI诊断的灵敏度和特异度分别为0.95、0.90和0.90、0.95,对UAP诊断的灵敏度和特异度分别为0.95、0.90和0.90、0.95.结论 血清sgp130、hsCRP浓度的变化对AMI和UAP具有较高的诊断准确度,其变化的程度可以作为炎症反应和病情严重的判断指标之一。
  
  【关键词】  冠状动脉疾病;糖蛋白类;C反应蛋白;诊断
  
  [ABSTRACT] Objective To explore the clinical significance of changes in serum levels of soluble glycoprotein130 (sgp130) and hypersensitive Creactive protein (hsCRP) in patients with coronary heart disease (CHD)。  Methods By using enzymelinked immunosorbent assay (ELISA) and light scattering rate nephelometry method, levels of sgp130 and hsCRP were measured in 20 patients with acute myocardial infarction (AMI), 20 unstable angina pectoris (UAP), and 20 stable angina pectoris (SAP)。 The results were compared with that of 20 healthy controls.   Results The serum sgp130 was lower, and hsCRP higher in patients with CHD than that in the controls (t=6.97,6.86;P<0.01)。 Significant differences in serum levels of sgp130 and hsCRP were noticed among the AMI, UAP and SAP patients (F=47.14,36.23;q=4.26-15.66;P<0.01)。 The serum sgp130 and hsCRP in patients with AMI were lower or higher than that of UAP, SAP and the controls (q=4.59-15.66,P<0.01); and that in patients with UAP were much lower or higher than that of patients with the SAP and the controls (q=4.26-11.06,P<0.01); and the difference of the levels of sgp130 in patients between SAP and the controls were significant (q=4.93,P<0.01)。 The level of sgp130 was negatively correlated with hsCRP in patients with CHD (r=-0.574,P<0.01)。 The areas under the ROC curve (AUCROC) were all greater than 0.9 with higher sensitivity and specificity. The sensitivity and specificity of sgp130 and hsCRP were 0.95/0.90 and 0.90/0.95 in patients with AMI. The sensitivity and specificity of sgp130 and hsCRP were 0.95/0.90 and0.90/0.95 in patients with UAP.  Conclusion The changes in levels of sgp130 and hsCRP have higher accuracy on the diagnosis of AMI and UAP, which can be used as one of the indexes for judgement of inflammation and severity of coronary heart disease.
  
  [KEY WORDS] coronary disease; glycoproteins; Creactive protein; diagnosis
  
  近年来的研究结果显示,多种因素的共同作用可引起动脉粥样硬化(AS),而冠状动脉内膜的损伤以及机体的非特异性炎症反应在冠心病(CHD)的发病机制中起了关键性作用[1].可溶性糖蛋白130(sgp130)和超敏C反应蛋白(hsCRP)是反映机体的炎症状态和程度的指标,IL6是冠心病发病中的重要炎性因子,而sgp130则是IL6发挥生物学作用过程中重要的信号分子[2].研究表明,CRP与CHD的发生、发展和预后有着密切的关系,CRP的浓度变化可反映动脉粥样硬化的病变程度,预测CHD事件的发生[3].本研究通过观察CHD病人血清sgp130、hsCRP水平变化及两者关系,旨在进一步探讨两者在CHD发病中的作用与意义。
  
  2期逄帅,吕文辉,李大鹏,等。 冠心病病人血清sgp130与hsCRP变化及其意义133
  
  1  对象与方法
  
  1.1  研究对象
  
  1.1.1  CHD组
  
  选取青岛大学医学院附属医院2009年3—6月住院的CHD病人60例,男33例,女27例,年龄43——81岁,均符合1999年WHO关于CHD的诊断标准(经心电图、冠状动脉造影、生化及心肌酶检查明确诊断)。将病人分为3组,每组20例。①急性心肌梗死(AMI)组,男16例,女4例,平

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