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中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2016, Vol. 11 ›› Issue (03) : 204 -211. doi: 10.3877/cma.j.issn.1673-9450.2016.03.010

所属专题： 文献；

论著

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
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   
  1. 1. 223002　徐州医学院附属淮安医院老年病科
  • 收稿日期:2016-01-15 出版日期:2016-06-01
  • 通信作者: 李侠, 李霞
  • 基金资助:
    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)

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

Xia Li1,†(), Youdong Hu1, Fenglin Zhang1, Ying Chen1, Dianxuan Guo1, Hualan Zhou1, Xia Li1,†(), Qingna Zhao1   

  1. 1. Department of Geriatrics, Huaian Hospital Affiliated to Xuzhou Medical College, Huaian 223002, China
  • Received:2016-01-15 Published:2016-06-01
  • Corresponding author: Xia Li, Xia Li
  • About author:
    Corresponding author: Li Xia, Email:
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引用本文：

李侠, 胡有东, 张枫林, 陈颖, 郭殿选, 周华兰, 李霞, 赵庆娜. 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[J]. 中华损伤与修复杂志(电子版), 2016, 11(03): 204-211.

Xia Li, Youdong Hu, Fenglin Zhang, Ying Chen, Dianxuan Guo, Hualan Zhou, Xia Li, Qingna Zhao. Disscussion on influencing factors of coronary artery disease in elderly patients with coronary atherosclerotic heart disease[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2016, 11(03): 204-211.

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/mL、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/mL、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/mL、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/mL、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/mL、CD31＋(511±32)个/μL、CD14＋CD16＋(1.7±0.5)%、hs－CRP(1.9±0.2)mg/L与分别NYHA Ⅳ级组Ang1～7(10.0±1.2)pg/mL、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/mL、CD31＋(385±28)个/μL、CD14＋CD16＋(2.9±0.8)%、hs－CRP(2.1±0.8)mg/L与分别LVEF 25%～35%组Ang1～7(9.5±2.0)pg/mL、CD31＋(1644±54)个/μL、CD14＋CD16＋(13.0±1.6)%、hs－CRP(14.1±2.0)mg/L比较，差异均有统计学意义(P值均小于0.05)；6 min步行试验>450 m组Ang1～7(36.4±7.1)pg/mL、CD31＋(561±30)个/μL、CD14＋CD16＋(1.9±0.5)%、hs－CRP(2.1±0.9)mg/L与分别6 min步行试验<150 m组Ang1～7(10.1±0.9)pg/mL、CD31＋(1338±41)个/μL、CD14＋CD16＋(7.2±0.9)%、hs－CRP(18.7±1.5)mg/L比较，差异均有统计学意义(P值均小于0.05)。

结论

Ang1～7水平下降，CD31＋、CD14＋CD16＋和hs－CRP表达水平的增高可能影响老年冠状动脉病变的严重程度。

关键词: 冠状动脉疾病, 老年人, 内皮细胞, 单核细胞
Objective

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: NYHA Ⅰ group, NYHA Ⅱ group, NYHA Ⅲ group and NYHA Ⅳ group. 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 significant, all P values were less than 0.05. Ang1-7(38.7±7.9)pg/mL, CD31+ (496±30)/μL, CD14+ CD16+ (2.1±0.7)%, hs-CRP(1.9±0.9)mg/L in single vessel lesion group vs Ang1-7(11.2±2.0)pg/mL, CD31+ (1583±52)/μL, CD14+ CD16+ (10.6±1.4)%, hs-CRP(14.9±1.9)mg/L in four vessel disease group, the differences were statistically significant, all P values were less than 0.05. NYHAⅠ group Ang1-7(38.5±2.7)pg/mL、CD31+ (511±32)/μL、CD14+ CD16+ (1.7±0.5)%、hs-CRP(1.9±0.2)mg/L vs NYHA Ⅳgroup Ang1-7(10.0±1.2)pg/mL、CD31+ (1598±49)/μL、CD14+ CD16+ (12.1±1.4)%、hs-CRP(15.0±1.9)mg/L, the differences were statistically significant, all P values were less than 0.05; LVEF 48%-58% group Ang1-7(32.9±6.8)pg/mL、CD31+ (385±28)/μL、CD14+ CD16+ (2.9±0.8)%、hs-CRP(2.1±0.8)mg/L vs LVEF 25%-35% group Ang1-7(9.5±2.0)pg/mL、CD31+ (1644±54)/μL、CD14+ CD16+ (13.0±1.6)%、hs-CRP(14.1±2.0)mg/L, the differences were statistically significant, all P values were less than 0.05; 6 min walk test Ang1-7(36.4±7.1)pg/mL、CD31+ (561±30)/μL、CD14+ CD16+ (1.9±0.5)%、hs-CRP(2.1±0.9)mg/L in >450 m group vs Ang1-7(10.1±0.9)pg/mL、CD31+ (1338±41)/μL、CD14+ CD16+ (7.2±0.9)%、hs-CRP(18.7±1.5)mg/L in <150 m group, the differences were statistically significant, all P values were less than 0.05.

Conclusions

The decrease in the level of Ang 1-7 and increase in the levels of CD31+ 、CD14+ CD16+ and hs-CRP maybe affect the degree of coronary artery stenosis in elderly patients with coronary artery disease.

Key words: Coronary artery disease, Aged, Endothelial cells, Monocytes
表1 140例老年冠状动脉粥样硬化性心脏病患者按照冠状动脉狭窄程度分组及基本资料
组别 例数 性别(男/女) 年龄(岁) 平均年龄(岁，±s)
75%～84%组 50 33/17 65～74 69.5±5.7
85%～94%组 54 27/27 70～77 73.5±6.5
95%～100%组 36 19/17 73～83 78.1±7.4
表2 140例老年冠状动脉粥样硬化性心脏病患者按照冠状动脉病变支数分组及基本资料
组别 例数 性别(男/女) 年龄(岁) 平均年龄(岁，±s)
单支病变组 45 28/17 67～75 71.1±6.4
双支病变组 47 25/22 65～78 72.5±6.9
三支病变组 28 15/13 69～79 74.0±7.2
四支病变组 20 11/9 72～83 77.4±8.5
表3 140例老年冠状动脉粥样硬化性心脏病患者按照美国NYHA分级分组及基本资料
组别 例数 性别(男/女) 年龄(岁) 平均年龄(岁，±s)
NYHA Ⅰ级组 37 21/16 65～78 71.5±6.4
NYHA Ⅱ级组 39 24/15 67～77 72.4±5.9
NYHA Ⅲ级组 35 18/17 66～67 71.2±6.9
NYHA Ⅳ级组 29 16/13 65～80 72.5±7.3
表4 140例老年冠状动脉粥样硬化性心脏病患者按照LVEF分组及基本资料
组别 例数 性别(男/女) 年龄(岁) 平均年龄(岁，±s)
48%～58%组 44 23/21 65～77 71.2±7.3
36%～47%组 56 31/25 67～78 72.7±8.5
25%～35%组 40 25/15 68～80 74.7±8.1
表5 140例老年冠状动脉粥样硬化性心脏病患者按照6 min步行试验的步行距离分组及基本资料
组别 例数 性别(男/女) 年龄(岁) 平均年龄(岁，±s)
>450 m组 61 33/28 66～70 68.5±7.4
150～450 m组 50 31/19 69～75 72.5±7.7
<150 m组 29 15/14 75～83 71.2±7.3
表6 140例不同程度冠状动脉狭窄的老年冠状动脉粥样硬化性心脏病患者与健康对照组人群外周血Ang1～7、CD31＋、CD14＋CD16＋和hs－CRP的水平(±s)
组别 例数 Ang1～7(pg/mL)) CD31＋(个/μL) CD14＋CD16＋(%) hs－CRP(mg/L)
健康对照组 50 35.9±7.8 469±29 1.9±0.7 1.8±0.5
75%～84%组 50 34.8±6.9 471±29 1.4±0.3 1.7±0.8
85%～94%组 54 21.6±1.1 1021±45 3.7±0.5 9.5±0.9
95%～100%组 36 9.1±0.4 1554±40 5.9±0.8 17.1±1.5
F值 ? 778.00 863.98 607.50 888.70
P值 ? 0.009 0.006 0.008 0.005
t1值 ? 105.3 112.4 135.2 131.4
P1值 ? <0.05 <0.05 <0.05 <0.05
t2值 ? 169.7 158.1 146.1 192.1
P2值 ? <0.05 <0.05 <0.05 <0.05
t3值 ? 231.1 198.2 241.6 248.6
P3值 ? <0.05 <0.05 <0.05 <0.05
t4值 ? 144.6 156.3 164.1 176.1
P4值 ? <0.05 <0.05 <0.05 <0.05
t5值 ? 172.3 181.5 179.5 192.1
P5值 ? <0.05 <0.05 <0.05 <0.05
t6值 ? 146.7 162.4 161.3 162.5
P6值 ? <0.05 <0.05 <0.05 <0.05
表7 健康对照组人群与冠状动脉单支、双支、三支和四支病变组的老年冠状动脉粥样硬化性心脏病患者外周血Ang1～7、CD31＋、CD14＋CD16＋和hs－CRP的水平(±s)
组别 例数 Ang1～7(pg/mL) CD31＋(个/μL) CD14＋CD16＋(%) hs－CRP(mg/L)
健康对照组 50 37.9±7.5 501±31 2.7±0.9 1.5±0.3
单支病变组 45 38.7±7.9 496±30 2.1±0.7 1.9±0.9
双支病变组 47 30.2±2.3 980±51 5.5±1.1 6.0±1.2
三支病变组 28 23.5±1.9 1211±49 7.9±1.31 9.7±1.6
四支病变组 20 11.2±2.0 1583±52 10.6±1.4 14.9±1.9
F值 ? 125.34 104.40 177.80 330.18
P值 ? 0.008 0.009 0.006 0.003
t1值 ? 90.4 114.9 120.1 214.8
P1值 ? <0.05 <0.05 <0.05 <0.05
t2值 ? 171.6 352.5 341.4 382.6
P2值 ? 0.000 <0.05 <0.05 <0.05
t3值 ? 201.3 459.6 471.4 478.3
P3值 ? <0.05 <0.05 <0.05 <0.05
t4值 ? 256.2 601.5 562.4 611.6
P4值 ? <0.05 <0.05 <0.05 <0.05
t5值 ? 124.8 431.4 483.5 441.8
P5值 ? <0.05 <0.05 <0.05 <0.05
t6值 ? 162.8 669.2 701.3 668.2
P6值 ? <0.05 <0.05 <0.05 <0.05
t7值 ? 248.2 829.3 871.2 879.6
P7值 ? <0.05 <0.05 <0.05 <0.05
t8值 ? 136.9 829.2 841.9 898.6
P8值 ? <0.05 <0.05 <0.05 <0.05
t9值 ? 183.1 879.8 865.1 903.8
P9值 ? <0.05 <0.05 <0.05 <0.05
t10值 ? 126.4 693.1 713.5 913.8
P10值 ? <0.05 <0.05 <0.05 <0.05
表8 健康对照组人群与NYHA各分级组的老年冠状动脉粥样硬化性心脏病患者外周血Ang1～7、CD31＋、CD14＋CD16＋和hs－CRP的水平(±s)
组别 例数 Ang1～7(pg/mL) CD31＋(个/μL) CD14＋CD16＋(%) hs－CRP(mg/L)
健康对照组 50 35.1±7.8 498±29 2.0±0.7 1.7±0.6
NYHA Ⅰ级组 37 38.5±2.7 511±32 1.7±0.5 1.9±0.2
NYHA Ⅱ级组 39 26.1±1.9 1001±48 6.4±1.0 7.2±1.4
NYHA Ⅲ级组 35 19.7±1.6 1236±50 8.8±1.1 10.4±1.7
NYHA Ⅳ级组 29 10.0±1.2 1598±49 12.1±1.4 15.0±1.9
F值 ? 137.39 107.28 108.43 245.75
P值 ? 0.007 0.009 0.009 0.003
t1值 ? 86.2 612.4 664.6 691.2
P1值 ? <0.05 <0.05 <0.05 <0.05
t2值 ? 102.3 731.4 694.8 713.4
P2值 ? <0.05 <0.05 <0.05 <0.05
t3值 ? 199.6 832.6 729.3 749.2
P3值 ? <0.05 <0.05 <0.05 <0.05
t4值 ? 223.7 882.1 784.2 798.1
P4值 ? <0.05 <0.05 <0.05 <0.05
t5值 ? 94.6 591.3 689.2 695.8
P5值 ? <0.05 <0.05 <0.05 <0.05
t6值 ? 137.2 613.4 731.5 752.6
P6值 ? <0.05 <0.05 <0.05 <0.05
t7值 ? 197.6 782.3 719.4 729.3
P7值 ? <0.05 <0.05 <0.05 <0.05
t8值 ? 123.6 623.3 682.8 691.7
P8值 ? <0.05 <0.05 <0.05 <0.05
t9值 ? 163.9 763.5 733.5 743.6
P9值 ? <0.05 <0.05 <0.05 <0.05
t10值 ? 143.8 823.1 793.2 789.5
P10值 ? <0.05 <0.05 <0.05 <0.05
表9 健康对照组人群与LVEF不同组的老年冠状动脉粥样硬化性心脏病患者外周血Ang1～7、CD31＋、CD14＋CD16＋和hs－CRP的水平(±s)
组别 例数 Ang1～7(pg/mL) CD31＋(个/μL) CD14＋CD16＋(%) hs－CRP(mg/L)
健康对照组 50 31.3±7.0 402±26 2.5±0.9 1.9±0.7
48%～58%组 44 32.9±6.8 385±28 2.9±0.8 2.1±0.8
36%～47%组 56 20.9±2.7 1030±49 8.1±1.3 8.0±1.5
25%～35%组 40 9.5±2.0 1644±54 13.0±1.6 14.1±2.0
F值 ? 456.30 494.82 306.30 424.30
P值 ? 0.009 0.009 0.004 0.003
t1值 ? 103.43 109.92 126.42 119.03
t2值 ? 123.03 154.18 162.86 145.92
t3值 ? 136.71 141.36 156.91 122.87
t4值 ? 98.6 913.1 958.1 986.4
t5值 ? 139.8 997.5 1138.3 1035.7
t6值 ? 95.2 982.8 1064.9 1012.5
表10 健康对照组人群6 min步行试验步行距离不同组的老年冠状动脉粥样硬化性心脏病患者外周血Ang1～7、CD31＋、CD14＋CD16＋和hs－CRP的水平(±s)
组别 例数 Ang1～7(pg/mL) CD31＋(个/μL) CD14＋CD16＋(%) hs－CRP(mg/L)
健康对照组 50 35.1±7.5 497±29 2.0±0.7 2.2±0.6
>450 m组 61 36.4±7.1 561±30 1.9±0.5 2.1±0.9
150～450 m组 50 23.5±1.6 943±37 4.5±0.7 10.5±1.1
<150 m组 29 10.1±0.9 1338±41 7.2±0.9 18.7±1.5
F值 ? 830.28 1071.71 842.70 2066.70
P值 ? 0.007 0.006 0.007 0.004
t1值 ? 119.5 131.3 107.8 129.4
t2值 ? 148.7 138.2 141.6 132.9
t3值 ? 126.3 142.9 108.3 130.5
t4值 ? 102.4 114.1 121.2 99.8
t5值 ? 149.1 134.3 141.3 132.8
t6值 ? 99.8 102.3 98.1 111.7
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