【作者】 姜忠信；

【导师】 刘成玉； 谭齐贤；

【作者基本信息】 青岛大学 ， 临床检验诊断学， 2002， 硕士

【摘要】 目的 观察冠状动脉粥样硬化性心脏病(CHD)病人凝血、纤溶及免疫指标的变化，以探讨凝血系统和免疫功能变化与CHD发病的关系，借以了解其对冠心病的诊断、抗凝及溶栓治疗的监测及判断预后的意义。同时，这些凝血、纤溶及免疫系统的分子标志物也可能为血栓形成性疾病的临床诊断与治疗提供依据。 方法 采用酶联免疫吸附(ELISA)双抗体夹心法，检测了100例CHD病人血浆血小板颗粒膜蛋白-140(GMP-140)，血管性血友病因子(vWF)，D-二聚体(D-D)含量及血清抗心磷脂抗体(ACL)平均结合指数(BI)的变化，并与42例健康人比较。 结果 CHD病人血浆D-D，GMP-140，vWF及血清ACL平均结合指数明显增高，与对照组比较差异有显著性(t＝2.529～19.390，P＜0.05)，且急性心肌梗死(AMI)病人各指标变化明显高于陈旧性心肌梗死(OMI)、不稳定性心绞痛(UAP)和稳定性心绞痛(SA)病人(t＝3.264～14.409，F＝2.472～67.378，P＜0.01)，其中UAP病人血浆GMP-140明显高于SA(t＝3.236，P＜0.05)。CHD病人IgG-ACL，IgM-ACL，IgA-ACL阳性率分别是24.0％，18.0％，6.0％，AMI病人IgG-ACL，IgM-ACL阳性率分别为55.6％，44.4％，较UAP，SA增高更明显(x~2＝4.547～8.629，P＜0.05)，而AMI病人与OMI病人ACL阳性率比较无显著性差异(x~2＝2.391～3.326，P＞0.05)。CHD病人GMP-140，vWF，D-D，IgG-ACL水平之间呈明显的正相关性(r＝0.857～0.301，P＜0.05～0.01)；AMI病人的vWF，D-D与IgG-ACL，IgM-ACL水平呈明显的正相关性(r＝0.574～0.351，P＜0.05～0.01)，而其凝血、纤溶指标之间的相关性并不很明显；OMI病人的GMP-140，vWF，D-D各指标之间有明显的相关性(r＝0.385～0.425，P＜0.05)，vWF，D-D水平与IgG-ACL水平有相关性(r＝0.385～0.441，P＜0.05)；UAP，SA 中文拘要 病人GMP－140，vWF，hD各指标之间的相关性更明显（r—0．434～0．857， P＜0．01），而与互g二卜ACL的水平无明显的相关性。 结论CHD病人处于明显的高凝状态，且CHD病人血栓前状态分子标 志物水平与病情变化有一定关系，同时免疫功能变化在冠心病的发病中有一 定关系。更多还原

【Abstract】 Objective To explore the correlation between incidence of coronary heart disease (CHD) and the changes of molecular markers of coagulation,fibrinolysis and immuno-system in patients with CHD. This may help to diagnosis ,anticoagulation,thrombolysis and prognosis for patients with CHD. Concurrently, these molecular markers may contribute to screen , confirm and treat thrombotic diseases in clinic.Methods Plasma platelet granule membrane protein 140 (GMP-140), von Wille-brand factor (vWF), D-dimer(D-D) and median bound index of serum anticardiolipin antibodies (ACL) were detected by Enzyme Linked Immunosorbent Assay(ELISA) in 100 patients with CHD ,and compared with 42 healthy subjects.Results Plasma GMP-140,vWF , D-D and ACL were significantly elevated in patients with CHD and differed significantly compared with control group(f = 2. 529 -19. 390,P<0. 05). The changes of molecular markers in patients with acute myocardial infarction (AMI) were elevated significantly than those with old myocardial infarction (OMI), unstable agina pectoris (UAP) and stable agina (SA) (t=3. 264-14. 409, F= 2. 472 - 67. 378, P<0. 01). The levels of plasma GMP-140 in patients with UAP were elevated signifi cantly than those with SA(t=3. 236, P<0. 05). The positive rates of IgG-ACL, IgM-ACL and IgA-ACL in patients with CHD were 24. 0%,18. 0%,6. 0% respectively. The positive rates of ACL in patients with AMI were 55. 6%,44. 4% respectively and elevated significantly than those with UAP, SA (x2=4. 547-8. 629,P< 0. 05),and dominated by the types of IgG and IgM. But there is no significant difference between the AMI group and OMI group on positive rates of ACL(^2 =2. 391 - 3. 326, P>0. 05). There were significant correlations between the molecular markers in patients with CHD(r=0. 857 - 0. 301 , P<0. 05 - 0. 01). The levels of vWF and D-D were significantly corre lated with the levels of IgG-ACL and IgM-ACL in patients with AMI (r= 0. 574-0. 351,P<0. 05 - 0. 01). The levels of GMP-140,vWF and D-D were associated with each other closely (r=0. 385 - 0. 425, P<0. 05), while only the levels ofvWF and D-D were correlated with the levels of IgG-ACL in patients with OMI (r = 0. 385-0. 425,P<0. 05). Although the levels of GMP- 140, vWF and D-D were correlated with each other significantly(r=0. 857-0. 434, P<0. 01),they were not correlated with the levels of IgG-ACL.Conclusion There existed an obvious hypercoagulable state in patients with CHD. There were correlations between the changes of molecular markers of prethrombotic state and patients’ condition. At the same time, immunual factors contribute to the process and severity of CHD. Combination of quantitative determination of different prethrombotic molecular markers and ACL are valuable for diagnosis of prethrombotic state in CHD , as well as for investigation of the pathophysiological mechanism of this disorder.更多还原