感染性心内膜炎患者血浆可溶性E-选择素和P-选择素的检测及其临床意义  

Soluble E-selectin and P-selectin in patients with infective endocarditis

作　　者：侯晓霞[1] 韩凤英[2] 刘松岩[3] 

机构地区：[1]兰州军区乌鲁木齐总医院,乌鲁木齐830000 [2]解放军第23医院 [3]武警新疆总队医院

出　　处：《中国现代医学杂志》2003年第22期66-68,共3页China Journal of Modern Medicine

摘　　要：目的　探讨血浆可溶性E -选择素和P -选择素在感染性心内膜炎 (IE)患者血栓形成过程中 ,对炎症诱导的凝血因子前体 (酶原 )变化和内皮细胞活性改变的作用。方法　 6 3例感染性心内膜炎患者纳入研究 ,并在开始抗生素治疗 3d内 ,完成经食道超声心动图 (TEE)检查 ,其中 15例住院期间发生栓塞事件。另将同期门诊健康体检者 35例设为对照组 ,于入院 /门诊体检时空腹抽外周静脉血测IE患者中发生血栓事件者和未发生血栓事件者及正常对照组的血浆sE -SLT和sP -SLT水平。结果　IE栓塞 (+)组赘生物检出率较高 ,但与IE栓塞 (- )组比较 ,两者之间差异不显著 (86 .7%vs 6 2 .5 % ,P >0 .0 5 ) ,但前者赘生物的最大径较后者大 ,并有显著差异 [(13± 5 )mmvs (9± 4 )mm ,P <0 .0 5 ]。IE栓塞 (+)组血浆sP -SLT水平明显增高 ,与IE栓塞 (- )组和对照组比较均差异显著 [(6 0 .31± 6 .6 3) μg/Lvs (30 .72± 5 .33) μg/L ,P <0 .0 0 1,和(6 0 .31± 6 .6 3) μg/Lvs (2 7.39± 5 .5 8) μg/L ,P <0 .0 0 1]。同样 ,IE栓塞 (+)组血浆sE -SLT水平也明显增高 ,与IE栓塞 (- )组和对照组比较都差异显著 [(76 .0 6± 9.37) μg/Lvs (4 0 .6 5± 6 .6 9) μg/L ,P <0 .0 0 1和(76 .0 6± 9.37) μg/Lvs (37.2 3± 5 .76 ) μg/Objective:To study the role of plasma soluble adhesion molecules E- and P- selectin in inflammation-induced procoagulant changes and endothelial cell activation with thromboembolic complications of infective endocarditis.Methods:The study group consisted of 63 consecutive patients with defimite infective endocarditis according to the Duke criteria. Fifteen of the patients had embolic events. Transoesophageal echocardiographic examinations were performed on all patients within 3 days of initiations of amimicrobial therapy. The control group consisted of 35 age- and sex-adjusted healthy subjects. To measure E- and P-seleefin levels, peripheral venous blood samples were taken from patients with and without embolic events and healthy subjects.Results:It was found that there was a trend towards a higher rate of vegetations detected in those with embolic events than in those without. This did not have statistical significance (86.7% vs 62.5%. P>0.05).Significantly larger vegetations were observed in patients with embolic events as compared to those without embolic events [(1.3±0.5)cm vs (0.9± 0.4)cm,P<0.05].The mean plasma concentrations of P- selectin were elevated in patients with embolic events as compared to both patients without embolic events and control subjects [(60.31±6.63)μg/L vs (30.72 ± 5.33)μg/L,P<0.001 and (60.31 ± 6.63)μg/L vs (27.39±5.58)μg/L,P<0.001].Similarly, the patients with embolic events had increased plasma levels of E-selectin compared to those without embolic events and the control group [(76.06±9.37) μg/L vs (40.65 ±6.69)μg/L,P<0.001 and (76.06±9.37)μg/L vs(37.23 ± 5.76) μg/L,P<0.001].Conclusion:Determination of these membrane activation molecules may provide useful markers with which to identify patients at high thromboembolic risk from infective endocarditis.

关 键 词：感染性心内膜炎 栓塞事件 E-选择素 P-选择素 

分 类 号：R541.42[医药卫生—心血管疾病]