【作者】 王国凤；

【导师】 申晓彧；

【作者基本信息】 山西医科大学 ， 心血管内科， 2009， 硕士

【摘要】 目的:观察冠心病及冠心病合并糖尿病患者血清P-选择素水平,分析其与血糖、血脂各项之间的关系,评价P-选择素、血糖,血脂各项在冠心病中血小板活化、及疾病病情判断,危险分层及预后估计中的意义。方法:以30例疑似病例者为对照组,102例入选患者,其中58例冠心病组(B组),冠心病组又分为不稳定型心绞痛组(B1组)28例和急性心梗组(B2组)30例;44例冠心病合并2型糖尿病组(C组),C组也分为不稳定型心绞痛组(C1组)24例和急性心梗组(C2组)20例,分别测定其血清P-选择素、空腹血糖、果糖胺、糖化血红蛋白、血脂等各项指标,并进行一般项目检查。P-选择素采用酶联免疫法测定;糖化血红蛋白采用胶体滤过法,血脂系列(包括TC、TG、LDL、HDL)及果糖胺、空腹血糖的检测采用常规生化法测定。结果:1)冠心病组及冠心病合并糖尿病组患者血清P-选择素水平均明显高于正常对照组(P＜0.05);2)冠心病合并糖尿病组与单纯冠心病组相比,血清P-选择素水平明显升高(P＜0.05);3)冠心病组、冠心病合并糖尿病组中,急性心梗与不稳定型心绞痛两组间相比较,急性心梗组血清P-选择素水平明显升高(P＜0.05);4)病例组中血清P-选择素与低密度脂蛋白LDL呈正相关(R~2=0.498,0.572,0.468.0.517,P＜0.05);与TC呈正相关(R~2=0.403,0.512,0.423,0.508,P＜0.05);与HDL呈负相关(R~2=-0.408,-0.439,-0.501,-0,489,P＜0.05)C组与空腹血糖水平呈正相关(R~2=0.362,0.431,P＜0.05);与果糖胺水平呈正相关(R~2=0.264,0.401,P＜0.05);与糖化血红蛋白呈正相关(R~2=0.206,0.375,P＜0.05);结论:1)冠心病患者血清可溶性P-选择素水平显著高于正常人,其中AMI患者又较UA患者明显增高,说明UA及AMI患者存在血小板高活性状态,提示急性心梗较不稳定型心绞痛血小板活化更严重;它们的发生、发展与血小板功能亢进及血栓形成所致心肌缺血密切相关。2)冠心病患者的总胆固醇、低密度脂蛋白胆固醇和P-选择素水平呈正相关,提示血脂可能有刺激血管炎症反应、激活血小板的作用。3)冠心病合并糖尿病组血清P-选择素水平则较单纯冠心病组进一步升高,提示血糖升高在血小板活化,血清P-选择素水平增高的发展中可能起一定作用。更多还原

【Abstract】 Objective:To investigate changes in contents of human P-selectins and lipid(LDL,HDL,TQTC),and blood glucose(FBG,HBA1C,)in coronary heart disease(CHD),coronary heart disease with diabetic mellitus(DM).Analysis the relationship of P-selectins and lipid and blood glucose in CHD.Then evaluate the significances of P-selectins and lipid and blood glucose in platelet activation,destabilization of plaque,and predictor of future cardiovascular events.Methods:P-selectin,TC,TG,LDL,HDL,FBG,HbAlC,FTU,of l02 patients who were selected, were determined and compared to those of 30 patients healthy persons as control group.Among these patients,28 cases were unstable angina pectoris(group Bl),30 cases were acute myocardial infarction(group B2),24 cases were unstable angina pectoris complicating diabetic (group C1),20 cases were acute myocardial infarction complicating diabetic(group C2).The levels of P-selectin were measured by enzyme-linked immunosorbentassay(ELISA)technique and serum lipid(TC,TG,LDL,HDL,)and fasting blood glucose were measured by common practice examine.HBA1C were measured by latex agglutination immunoassay.Results:1)The level of P-selectins in CHD,CHD complicating with DM is obviously higher than in the normal control group(P＜0.05).The difference is statistically significant.2)The level of P-selectins in CHD complicating with DM is obviously higher than in CHD group(P＜0.05).The difference is also statistically significant.3)The level of P-selectins in AMI group is obviously higher than in the UAP group(P＜0.05).The difference is also statistically significant.4)Pearson relation analysis showed that P-selectins level had significant positive correlation with LDL(R~2=0.498,0.572,0.468,0.517,P＜0.05),TC(R~2=0.403,0.512,0.423,0.508,P＜0.05),FBS(R~2=0.362,0.431,P＜0.05),FRU (R~2=0.264,0.401,P＜0.05),HBA1C(R~2=0.206,0.375,P＜0.05);and had appositive correlation with HDL(R~2=-0.408,-0.439,-0.501,-0.489,P,0.05)Conclusion:1)CHD patients have higher level of P-selectin which indicates that platelet activation is more serious in AMI patients than in UAP patients.2)There are obvious positive correlation between the levels of P-selectin and lipids in patients with CHD.The total cholesterol and low density lipoprotein cholesterol may exacerbate the endothelial dysfunction,aggravate the systemic inflammation and activate the platelet in patients with CHD and CHD.complicating DM.3)The serum P-selectin level in the CHD complicating DM is obviously higher than in the CHD.It shows that the blood glucose may exacerbate the endothelial dysfunction,aggravate the systemic inflammation and activate the platelet in patients with CHD complicating diabetic.更多还原