[1]张 萍,杨 静.风湿性心脏病伴房颤患者血浆sVCAM-1水平和eNOSmRNA表达与心内血栓形成的相关性研究[J].现代检验医学杂志,2019,34(02):27-31.[doi:10.3969/j.issn.1671-7414.2019.02.008]
　ZHANG Ping,YANG Jing.Relationship of sVCAM-1 Level and eNOSmRNA Expressionin Plasma in Response to Cardiac Thrombosis for the Patientswith Rheumatic Heart Disease and Atrial Fibrillation[J].Journal of Modern Laboratory Medicine,2019,34(02):27-31.[doi:10.3969/j.issn.1671-7414.2019.02.008]
点击复制

风湿性心脏病伴房颤患者血浆sVCAM-1水平和eNOSmRNA表达与心内血栓形成的相关性研究()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第34卷
期数:
2019年02期
页码:
27-31
栏目:
论著
出版日期:
2019-05-11

文章信息/Info

Title:
Relationship of sVCAM-1 Level and eNOSmRNA Expressionin Plasma in Response to Cardiac Thrombosis for the Patientswith Rheumatic Heart Disease and Atrial Fibrillation
文章编号:
1671-7414(2019)02-027-05
作者:
张 萍; 杨 静
(陕西省商洛市中心医院检验科,陕西商洛 726000)
Author(s):
ZHANG Ping; YANG Jing
(Department of Clinical Laboratory,Shangluo Central Hospital,Shaanxi Shangluo 726000,China)
关键词:
风湿性心脏病;  血栓形成;  可溶性血管细胞黏附分子-1;  内皮型一氧化氮合酶;  D-二聚体;  左房内径
分类号:
R541.2; R446.112
DOI:
10.3969/j.issn.1671-7414.2019.02.008
文献标志码:
A
摘要:
目的 探讨血浆可溶性血管细胞黏附分子-1(sVCAM-1)水平和内皮型一氧化氮合酶(eNOS)mRNA的表达在风湿性心脏病(rheumatic heart disease,RHD)伴房颤患者心内血栓形成中的临床应用。方法 收集2015年7月～2018年7月在陕西省商洛市中心医院心内科住院治疗的58例RHD患者的血液及临床资料进行回顾性分析,依据是否有心内血栓形成分为血栓组(28例)和无血栓组(30例)。采用实时逆转录-聚合酶链反应(RT-PCR)技术检测血浆eNOSmRNA的表达,采用酶联免疫吸附法检测血浆sVcAM-1水平。同时建立健康对照组(33例),比较分析以上指标的变化与RHD心内血栓形成的关系。结果 血浆eNOSmRNA在血栓组、无血栓组和对照组中的表达分别为0.21±0.05,0.49±0.13和0.99±0.27; 而血浆sVCAM-1在三组中的水平则分别为11.3±5.2,7.7±3.5和3.7±2.1 ng/L。与对照组比较,血浆sVCAM-1水平在血栓组和无血栓组中显著上调,而eNOSmRNA的表达则显著下调,其中血栓组两标志物的表达上调或下调更显著,以上结果的比较差异均有统计学意义(t=15.29～43.23,均P<0.01)。左房内径(LAD),D-二聚体(D-D)和收缩压(SBP)在血栓组、无血栓组和对照组中的结果分别为55.3±3.2,45.9±2.7和36.3±2.9 mm,2.83±0.67,1.67±0.32和0.35±0.19 mg/L,126.1±8.3,124.9±8.9和124.5±8.7 mmHg。血栓组和无血栓组的左房内径与对照组比较明显增大,血栓组增大更显著。血栓组和无血栓组的D-D水平高于对照组,其中血栓组D-D水平增高更显著。以上结果比较的差异均有统计学意义(t=9.67～37.97,均P<0.01)。各组间SBP的比较差异均无统计学意义(t=0.65～1.13,均P>0.05)。在血栓组和无血栓组中,sVCAM-1和eNOSmRNA分别与D-D水平和LAD具有相关性(r=0.839,-0.829,P<0.01),(r=0.799,-0.782,P<0.01)。sVCAM-1和eNOSmRNA诊断血栓形成的敏感度和特异度分别为70.3%和81.5%,77.3%和85.7%。以血栓组和无血栓组为因变量,sVCAM-1和eNOSmRNA的AUC分别为0.853(95%CI:0.747～0.960,P<0.01)和0.846(95%CI:0.736～0.957,P<0.01)。结论检测风湿性心脏病患者血浆sVCAM-1水平和eNOSmRNA表达可用于评价体内的凝血活性及纤溶活性,预测血栓形成的风险。
Abstract:
Objective To investigate the clinical application of plasma sVCAM-1 levels and eNOSmRNA expression in thrombosis of rheumaticheart disease(RHD)with atrial fibrillation.Methods Theblood and clinical data of 58 patients with(RHD)hospitalized in the department of cardiology from Shangluo Central Hospital,Shaanxi Province between July 2015 and July 2018 were retrospectively analyzed.They were divided into thrombosis group(28 cases)and non-thrombosis group(30 cases)according to whether there was intracardiac thrombosis.The levels of plasma sVCAM-1 and eNOSmRNA weredetected by the methods of ELISA and PT-PCR.At the same time,a healthy control group(33 cases)was established to compare and analyze the relationship between the changes of the above indicators and intracardiac thrombosis in(RHD).Results The plasma expression of eNOSmRNA in thrombosis group,non-thrombosis group and control group were 0.21±0.05,0.49±0.13 and0.99±0.27,respectively,while the plasma level of sVCAM-1 in three groups was 11.3±5.2,7.7±3.5 and 3.7±2.1 ng/L,respectively.Compared with the control group,the plasma sVCAM-1 level was significantly increased whereas the expression of eNOSmRNA was significantly decreased in thrombosis group and non-thrombosis group.Further,the expression of the two markers was more significant in thrombosis group,and the differences were statistically significant(t=15.29～43.23,all P<0.01).The results of left atrial diameter(LAD),D-dimer(D-D)and systolic blood pressure(SBP)in thrombosis group,non-thrombosis group and control group were 55.3±3.2,45.9±2.7 and 36.3±2.9 mm,2.83±0.67,1.67±0.32 and 0.35±0.19 mg/L,126.1±8.3,124.9±8.9 and 124.5±8.7mmHg,respectively.Compared with the control group,the diameter of left atriuminthrombosis group and non-thrombosis group increased significantly,especially in thrombosis group.D-D level of thrombosis group and non-thrombosis groupwas significantly higher than that of control group,and that of thrombosis group was more significant.There were significant differences in the above results(t=9.67～37.97,all P<0.01).There was no significant difference in SBP among groups(t=0.65～1.13,all P>0.05).In thrombosis group and non-thrombosis group,sVCAM-1 and eNOSmRNA were correlated with plasma D-D leveland LAD respectively(r=0.839,-0.829,P<0.01),(r=0.799,-0.782,P<0.01).The sensitivity and specificity of sVCAM-1 and eNOSmRNA in diagnosing thrombosis progression at the optimal threshold were 70.3% and 81.5%,77.3% and 85.7%,respectively.The AUCs of sVCAM-1 and eNOSmRNA were 0.853(95% CI:0.747～0.960,P<0.01)and 0.846(95% CI:0.736～0.957,P<0.01)respectively.Conclusion The levels of plasma sVCAM-1 and eNOSmRNA in patients with(RHD)can be used to determine the coagulation activity and fibrinolysis,and to predict the risk of thrombosis.

参考文献/References:

[1] WANTKINS D A,JOHNAON C O,COLQUHOUN S M,et al.Global,regional,and national burden of rheumatic[J].Heart Disease,2017,377(8):713-722.
[2] DONG Haiyun, SUN Yongmei, SHAN Xiaofeng,et al.Down-regulation of miR-101 contributes to rheumatic heart disease through up-regulating TLR2[J].Med Sci Monit,2015,21:1500-1506.
[3] 侯敏,曾非,黄菲菲.尿激酶溶栓联合阿司匹林治疗风湿性心脏病左心房内血栓脱落致脑栓塞的疗效[J].中国实用神经疾病杂志,2017,20(1):7-10. HOU Min,ZENG Fei,HUANG Feifei.Efficacy of urokinase thrombolysis combined with aspirin in the treatment of cerebral embolism caused by the fall-off of embolus from left atrium in patients with rheumatic heart diseases[J].Chinese Journal of Practical Neurological Diseases,2017,20(1):7-10.
[4] FURIE B,FLAUMENHAFT R.Thiol isomerases in thrombus formation[J].CircRes,2014,114(7):1162-1173.
[5] SANTOS J C D,CRUZ M S,BORTOLIN R H,et al.Relationship between circulating VCAM-1,ICAM-1,E-selectin and MMP9 and the extent of coronary lesions[J].Clinics(Sao Paulo Brazil),2018,73:e203.
[6] 姜建,刘煜敏,孔朝红,等.风湿性心脏病伴发脑栓塞患者脑血流动力学初探[J].临床与病理杂志,2016,36(9):1283-1287. JIANG Jian,LIU Yumin,KONG Chaohong,et al.Evaluation of hemodynamics in stoke patients caused by thrombosis of rheumatic heart disease[J].Journal of Pathology and Clinical Medicine,2016,36(9):1283-1287.
[7] GUO Furong,YI Xin,LI Mingjiang,et al.Snaill is positively correlatedwith atrial fibrosis in patients with atrial fibrillation and rheumatic heart disease[J].Experimental & Therapeutic Medicine,2017,14(5):4231-4237.
[8] 周春亭,王朝晖.吸入外源性一氧化氮对急性缺血性卒中患者血管内皮细胞功能、血小板功能及血栓形成的影响[J].实用心脑肺血管病杂志,2016,24(2):63-65. ZHOU Chunting,WANG Zhaohui.Impact of inhalation of exogenous nitric oxide on vascular endothelial cell function,platelet function and thrombosis of patients with acute ischemic stroke[J].Practical Journal of CardiacCerebral Pneumal and Vascular Disease,2016,24(2):63-65.
[9] 谭强,李广平,齐曦明,等.永久性心房颤动老年患者内皮祖细胞功能变化及其临床意义[J].中华老年医学杂志,2017,36(11):1171-1175. TAN Qiang,LI Guangping,QI Ximing,et al.Changes in endothelial progenitor cell function in elderly patients with permanent atrial fibrillation and their clinical significance[J].Chinese Journal of Geriatrics 2017,36(11):1171-1175.
[10] 葛卫力,米亚非,朱敏,等.转化生长因子β1对老年心房颤动患者内皮细胞向间质成纤维细胞转化的影响[J].中国老年学杂志,2017,37(22):5509-5511.GE Weili,MI Yafei,ZHU Min,et al.The effect of transforming growth factor beta 1 on the transformation of endothelial cells to mesenchymal fibroblastsin elderly patients with atrial fibrillation[J].Chinese Journal of Gerontology,2017,37(22):5509-5511.
[11] 董均明,马英丽,张紫阳,等.蓬子菜总黄酮对人脐静脉内皮细胞氧化损伤的保护作用及其机制[J].中华心血管病杂志,2016,44(7):610-615.DONG Junming,MA Yingli,ZHANG Ziyang,et al.Effects and related mechanism of flavone from Galium verum L on peroxide induced oxidative injury in human umbilical vein endothelial cells[J].Chinese Journal of Cardiovascular,2016,44(7):610-615.
[12] 周彬,余舒杰,刘定辉,等.SIRT1/eNOS/NO通路在人参皂苷Rb1抗内皮细胞复制性衰老中的作用[J].中国病理生理杂志,2018,34(10):1762-1768.ZHOU Bin,YU Shujie,LIU Dinghui,et al.Role of SIRT1/eNOS/NO signaling pathway in protective effect of ginsenoside Rb1 against replicative senescence ofendothelial cells[J].Chinese Journal of Pathophysiology,2018,34(10):1762-1768.
[13] 吴鸿,王新洲,高水波,等.益气活血方对凝血酶诱导内皮细胞促血栓因子表达的影响[J].中医学报,2017,32(9):1683-1685.WU Hong,WANG Xinzhou,GAO Shuibo,et al.E-ffect of Yiqi Huoxue decoction on expression of pro-thrombotic factor PAI-1 and TF in endothelial cells induced by thrombin[J].Journal of Chinese Medicine,2017,32(9):1683-1685.
[14] KIUCHI J,KOMATSU S,ICHIKAWA D,et al.Putative risk factors for postoperative pneumonia which affects poor prognosis in patients with gastric cancer[J].Int J Clin Oncol,2016,21(5):920-926.
[15] 张硕.吸烟与重型颅脑损伤患者肺部感染发生率的关系[D].银川:宁夏医科大学,2013.ZHANG Shuo.The relationship between smoking and pulmonary infection rateof severe craniocerebral injuryed patients[D].Yinchuan:Ningxia Medical University,2013.
[16] 孙富强,姜华,刘寅,等.风湿性心脏病心房颤动患者心房内皮型一氧化氮合酶的表达[J].临床心血管病杂志,2013,29(7):532-534.SUN Fuqiang,JIANG Hua,LIU Yin,et al.Expression of endothelial nitric oxide synthase in patients and rheumatic heart disease and atrial fibrillation[J].Journal of Clinical Cardiology(China),2013,29(7):532-534.
[17] PEZET S,TROUVIN A P,ELHAI M,et al.Linking systemic angiogenic markerstosynovial vascularization in rheumatoid arthritis[J].PLoS One,2018,13(9):e0203607.
[18] 郎玥,孙燕.风湿性心脏病患者形成左心房血栓危险因素分析[J].现代仪器与医疗,2017,23(6):83-84,90.LANG Yue, SUN Yan. Risk factors of left atrial thrombosis in patients with rheumatic heart disease[J].Modern Instruments and Medical Treatment,2017,23(6):83-84,90.
[19] 胡丽文,黄引平.熊脱氧酸对妊娠合并肝内胆汁淤积综合症患者血清甘胆酸、结合胆汁酸及sVCAM-1水平的影响[J].中国生化药物杂志,2016,36(11):44-46.HU Liwen,HUANG Yinping.Effect of ursodeoxycholic acid on serum glycocholic acid,conjugated bile acid and sVCAM-1 intrahepatic cholestasis of pregnancy[J].Chinese Journal of Biochemical Pharmaceutics,2016,36(11):44-46.
[20] CHEN Liping,LIU Hui,HUANG Yuan,et al.Expression of NFγB,ICAM1,andVCAM1 in rheumatic heart disease with atrial fibrillation[J].Anal Quant Cytopathol Histpathol,2013,35(5):249-252.
[21] GORTON D,SIKDER S,WILLIAMS N L,et al.Repeat exposure to group A Streptococcal M protein exacerbates cardiac damage in a rat model of rheumatic heart disease[J].Autoimmunity,2016,49(8): 563-570.
[22] 文鹤龄,魏薪,梁中书.风湿性心脏病二尖瓣病变患者瓣膜置换术前后左房血流动力学的超声评价[J].中国心血管杂志,2018,23(4):316-320.WEN Heling,WEI Xin,LIANG Zhongshu.Echo-cardiography evaluation of left atrial hemodynamic change's before and after valve replacement in patients with rheumatic mitral valve heart disease[J].Chinese Journal of Cardiology,2018,23(4):316-320.
[23] 戴学庆,涂秀,纪泽森.血液D-D,NT-proBNP和TropⅠ联合检测在急性胸痛症早期诊断中的价值[J].现代检验医学杂志,2018,33(4):115-118.DAI Xueqing,TU Xiu,JI Zesen.Value of combined detection of blood D-D,NT-proBNP and Trop I in the early diagnosis of acute chest pain[J].Journal of Modern Laboratory Medicine,2018,33(4):115-118.

备注/Memo

备注/Memo:
作者简介:张 萍(1987-),女,本科学历,医学学士,主管检验师,研究方向:医学检验技术的应用,E-mail:2634085934@qq.com。 通讯作者:杨 静(1987-),女,本科学历,医学学士,主管检验师,研究方向:医学检验技术的应用,E-mail:407205951@qq.com。 收稿日期:2018-12-26 修回日期:2019-01-14
更新日期/Last Update: 2019-04-30