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目的研究血浆血栓前体蛋白(TpP)和血清P选择素(Ps)水平在急性冠状动脉(冠脉)综合征(ACS)患者中的动态变化,探讨两者对ACS的预测价值。方法收集136例受试人群的末梢血,其中包括45例急性心肌梗死(AMI,AMI组)和31例不稳定心绞痛(UA,UA组)、30例稳定心绞痛(SAP,SAP组)和30例健康者(正常对照组)。从ACS中选取AMI经冠脉内支架植入术(PCI术)开通罪犯血管者25例作为冠脉再通组,经药物治疗后冠脉未通者20例作为冠脉未通组,用酶联免疫分析法(ELISA)定量测定受试人群的血浆TpP水平和血清Ps水平。结果正常对照组血浆TpP水平为(1.7±1.5)μg/ml,血清Ps水平为(11.5±4.5)μg/ml,SAP组血浆TpP水平为(2.3±1.4)μg/ml,血清Ps水平为(13.6±3.4)μg/ml,UA组血浆TpP水平为(6.2±2.1)μg/ml,血清Ps水平为(27.7±15.3)μg/ml,AMI组血浆TpP水平为(22.8±9.1)μg/ml,血清Ps水平为(46.2±18.1)μg/ml。正常对照组及SAP组血浆TpP水平及血清Ps水平比较,差异无统计学意义(P>0.05);UA组及AMI组血浆TpP水平及血清Ps水平均显著高于正常对照组(P<0.01)。AMI组血浆TpP水平及血清Ps水平明显高于UA组(P<0.01)。AMI患者诊断即可患者血浆TpP水平为(22.8±9.1)μg/ml,血清Ps水平为(46.2±18.1)μg/ml,冠脉未通组血浆TpP水平为(19.3±7.4)μg/ml,血清Ps水平为(40.6±13.4)μg/ml,冠脉再通组血浆TpP水平为(9.8±7.1)μg/ml,血清Ps水平为(15.2±7.6)μg/ml。冠脉未通组与AMI患者诊断即刻时的血浆TpP和血清Ps水平比较差异均无统计学意义(P>0.05);冠脉开通组患者TpP和Ps水平明显低于AMI诊断明确即刻时及冠脉未通组,差异具有统计学意义(P<0.01)。结论 TpP和Ps水平的升高与ACS的发生及冠脉病变严重程度密切相关,可以作为判断ACS患者粥样斑块是否稳定以及观察病情变化的血清学指标之一,也可作为AMI冠脉再通治疗是否成功的间接观察指标之一。
Objective To investigate the dynamic changes of plasma thromboplastin (TpP) and serum P-selectin (Ps) levels in patients with acute coronary syndrome (ACS) and to evaluate their predictive value for ACS. Methods Peripheral blood was collected from 136 subjects, including 45 patients with acute myocardial infarction (AMI, AMI) and 31 patients with unstable angina (UA, UA), 30 patients with stable angina (SAP, SAP) and 30 patients Healthy (normal control group). A total of 25 patients with coronary artery recanalization (AMI) were enrolled in this study. Twenty-five coronary artery recanalization (AMI) patients underwent coronary artery stent implantation (PCI) The level of plasma TpP and serum Ps in the test population were quantitatively determined by ELISA. Results The levels of plasma TpP and plasma Ps were (1.7 ± 1.5) μg / ml and (11.5 ± 4.5) μg / ml respectively in normal control group and (2.3 ± 1.4) μg / ml and (6.2 ± 2.1) μg / ml, serum Ps level was (27.7 ± 15.3) μg / ml in UA group, and (22.8 ± 9.1) μg / ml in AMI group , Serum Ps level was (46.2 ± 18.1) μg / ml. There was no significant difference in plasma TpP level and serum Ps level between normal control group and SAP group (P> 0.05). Plasma TpP level and serum Ps level in UA group and AMI group were significantly higher than those in normal control group (P <0.01) . Plasma TpP level and serum Ps level in AMI group were significantly higher than those in UA group (P <0.01). The level of plasma TpP was (22.8 ± 9.1) μg / ml in patients with AMI, (46.2 ± 18.1) μg / ml in serum, and (19.3 ± 7.4) μg / ml in non-coronary group, Serum Ps level was (40.6 ± 13.4) μg / ml, plasma TpP level was (9.8 ± 7.1) μg / ml and serum Ps level was (15.2 ± 7.6) μg / ml in coronary reperfusion group. There were no significant differences in plasma TpP and serum Ps between the patients with coronary artery failure and those with AMI at diagnosis (P> 0.05). The levels of TpP and Ps in patients with coronary artery open surgery were significantly lower than those with AMI There were significant differences between the two groups (P <0.01). Conclusions The elevated levels of TpP and Ps are closely related to the occurrence of ACS and the severity of coronary artery disease. They may be used as a serological marker to determine whether the atherosclerotic plaques in ACS patients are stable and to observe the changes of the disease. They may also be used as AMI coronary artery Indirect treatment of success is one of the indicators.