老年冠状动脉粥样硬化性心脏病患者冠状动脉病变影响因素的探讨  

Disscussion on influencing factors of coronary artery disease in elderly patients with coronary atherosclerotic heart disease

作　　者：李侠[1] 胡有东[1] 张枫林[1] 陈颖[1] 郭殿选[1] 周华兰[1] 李霞[1] 赵庆娜[1] 

机构地区：[1]徐州医学院附属淮安医院老年病科,223002

出　　处：《中华损伤与修复杂志（电子版）》2016年第3期204-211,共8页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：江苏省高校自然科学研究计划项目(KJD310234);江苏省卫生国际交流支撑计划项(JSWSGJ2012366);江苏省淮安市科技支撑计划项目(HAS2011020)

摘　　要：目的探讨循环人血管紧张素1~7(Ang1~7)、内皮细胞微颗粒CD31^+、单核细胞CD14^+CD16^+和超敏C-反应蛋白(hs-CRP)对老年冠状动脉粥样硬化性心脏病患者冠状动脉病变的影响。方法选择2010年1月至2014年3月老年冠状动脉粥样硬化性心脏病患者140例,健康对照组50例。根据冠状动脉狭窄程度将患者分为3组:75%~84%组,85%~94%组和95%~100%组;根据冠状动脉病变支数将患者分为4组:单支、双支、三支和四支病变组;再根据美国纽约心脏病学会(NYHA)分级将患者分为4组:NYHAⅠ、Ⅱ、Ⅲ、Ⅳ级组;又根据左心室射血分数(LVEF)进一步将患者分为3组:48%~58%组、36%~47%组和25%~35%组;根据6 min步行试验的步行距离又将患者分为3组:>450 m组、150~450 m组和<150 m组。采用流式细胞术检测血清CD31^+和CD14^+CD16^+水平的变化,使用双夹心抗体酶联免疫吸附法定量检测Ang1~7水平,应用免疫散射比浊法测定hs-CRP的水平。多组间差异采用单因素方差分析,组间两两比较采用t检验。结果冠状动脉狭窄75%~84%组Ang1~7(34.8±6.9)pg/m L、CD31^+(471±29)个/μL、CD14^+CD16^+(1.4±0.3)%、hs-CRP(1.7±0.8)mg/L分别与冠状动脉狭窄95%~100%组Ang1~7(9.1±0.4)pg/m L、CD31^+(1554±40)个/μL、CD14^+CD16^+(5.9±0.8)%、hs-CRP(17.1±1.5)mg/L比较,差异均有统计学意义(P值均小于0.05);冠状动脉单支病变组Ang1~7(38.7±7.9)pg/m L、CD31^+(496±30)个/μL、CD14^+CD16^+(2.1±0.7)%、hs-CRP(1.9±0.9)mg/L与分别冠状动脉四支病变组Ang1~7(11.2±2.0)pg/m L、CD31^+(1583±52)个/μL、CD14^+CD16^+(10.6±1.4)%、hs-CRP(14.9±1.9)mg/L比较,差异均有统计学意义(P值均小于0.05);NYHAⅠ级组Ang1~7(38.5±2.7)pg/m L、CD31^+(511±32)个/μL、CD14^+CD16^+(1.7±0.5)%、hs-CRP(1.9±0.2)mg/L与分别NYHAⅣ级组Ang1~7(10.0±1.2)pg/m L、CD31^+(1598±49)个/μL、CD14^+CD16^+(12.1±1.4)%、hs-CRP(15.0±1.9)mg/L比较,差异均有统计学意义(P值均小于0.05);LVEF 48%~58%组Ang1~7(32.9±6.8)pg/m L、CD31^+(38Objective To study the effects of circulation human angiotensin 1-7 （ Ang1-7 ）、CD31＋、CD14＋CD16＋ and hypersensitive C-reactive protein （ hs-CRP ） on coronary artery lesions in elderly patients with coronary artery disease. Methods One hundred and forty elderly patients with coronary artery disease were enrolled during the time period from January 2010 to March 2014 , 50 healthy persons were selected as the control group. According to the degree of coronary artery stenosis, the patients were divided into 3 groups：75% to 84% group, 85% to 94% group and 95% to 100% group. According to the number of diseased coronary arteries, the patients were divided into 4 groups： single vessel lesion group, double vessel lesion group, three branch lesion group and four vessel disease group. According to the New York Heart Association （ NYHA） classification, the patients were divided into 4 groups：NYHAⅠgroup, NYHAⅡ group, NYHAⅢgroup and NYHAⅣgroup. According to the left ventricular ejection fraction （ LVEF） , the patients were divided into 3 groups：48% to 58% group, 36% to 47% group and 25% to 35% group. According to the six-minute-walking-test, the patients were divided into 3 groups： 〉450 m group, 150-450 m group and〈150 m group. Flow cytometry were used to detect the changes of serum CD31＋and CD14＋CD16＋ levels. Double antibody sandwich enzyme-linked immunosorbent assay was used to quantitatively detect the levels of Ang1-7. The levels of hs-CRP were measured by immune scatter turbidity method. Multi group differences were analyzed by single factor analysis of variance, and t test was used to compare between the two groups. Results Patients with coronary artery stenosis showed Ang1-7（34. 8±6. 9）pg/mL, CD31＋（471±29）/μL, CD14＋CD16＋（1. 4±0. 3）%, hs-CRP（1. 7±0. 8）mg/L in 75%-84% group vs Ang1-7 （9. 1±0.4）pg/mL,CD31＋（1554±40）/μL,CD14＋CD16＋（5.9±0.8）%,hs-CRP （7.1±1.5）mg/L in 95%-100%group, the differences were statistically signif

关 键 词：冠状动脉疾病 老年人 内皮细胞 单核细胞 

分 类 号：R541.4[医药卫生—心血管疾病]