可溶性P-选择素与心血管易患因素关系的探讨  

Study of P-selectin and cardiovascular risk

作　　者：姚巍[1] 杨兰[1] 陈天铎[1] 李培杰[1] 马永华 

机构地区：[1]兰州医学院第二附属医院急救中心,730030 [2]嘉峪关铁路医院

出　　处：《中国急救医学》2002年第1期18-20,共3页Chinese Journal of Critical Care Medicine

基　　金：甘肃省急诊医学研究生资金项目部分内容

摘　　要：目的　P -选择素所介导的白细胞在血管内皮细胞上粘附和滚动已被认为是冠状动脉粥样硬化发病机制的重要因素之一 ,然而仍缺乏大量临床资料来评估可溶性P -选择素在心血管危险性所起的作用。方法　在 1 0 0 0 0余例健康女性体检者中随机选取 345例 ,其中有 1 1 5例随后发生心血管事件和 2 30例未发生心血管事件的患者血浆 ,同时观察心血管易患因素如吸烟、年龄、体重指数、糖尿病、高血压、高血脂等。结果　可溶性P -选择素水平在发生心血管事件的比没发生心血管事件的妇女高 (83 2∶69 3 ,P =0 0 0 3) ,每增加可溶性P -选择素的一个四分位数 ,心血管的危险性便增加一步 ,在最高四分位数与吸烟、年龄相关的危险因素是最低位数的 2 2倍 (95 %可信区间 1 0∶2 2 ,P =0 0 1 ) ,这些影响可不依赖传统的易患因素 ,在伴随肥胖、高血压、高血脂、糖尿病患者可溶性P -选择素在每增加一个四分位数心血管的危险性便增加 2 8%。与年龄、吸烟相关最高危险因素在妇女中P -选择素水平大于 1 37 3ng/mL在 95 %百分点。结论　可溶性PObjective P-selectin involved in leukocyte rolling and attachment,has been considered to play a role in initiation of atherosclerosis.However,little clinical datum are available evaluating the role of soluble P-selectin in determing cardiovascular risk Methods A sample of 340 were unselected to pick out in more than 10 000 women,they were divided into two groups,one group was 115 participants who subsequently developed cardiovascular risk events and the other was 230 participants who remained free of disease during 3 years of follow up.They were measured P-selectin by ELISA,and observed cardiovascular risk such as smoking?age?body mass index?hypertension?hyperlipidemia?diabetes etc Results Mean levels of soluble P-selectin were significantly higher among women who subsequently,experienced cardiovascular events compared with those who did not(83 2:69 3, P =0 003) The risk of future cardiovascular events increased with increasing quartiles of soluble P-selectin( P =0 02),such that women in the highest quartile at study entry had an age-and smoking-matched relative risk 2 2 times higher than those in the lowest quartile (95% confidence interval,1 2 to 4 2 ,P=0 01). This effect was independant of traditional risk factors.For each quartile increase in soluble P-selectin,the risk of future cardiovascular events increased 28%(P=0 03)after additional adjustment for obesity,hypertension,hyperlipidemia diabetes.The highest risks were observed among women with the very highest levels of P-selectin(>137 3 ng/mL,the 95th percentile cut point of the control distribution).Conclusion Soluble P-selectin levels are elevated among apparently healthy women at risk for future vascular events

关 键 词：炎症 P-选择素 动脉粥样硬化 危险因素 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病] R543.5[医药卫生—内科学]