血清可溶性E—选择素、谷氨酰转肽酶联合颈动脉内膜中层厚度检测在冠心病中的诊断价值

刘祖秋　俞飞虎　晏彪　陈华山　陈振云

[摘要] 目的 探究血清可溶性E-選择素、谷氨酰转肽酶（GGT）联合颈动脉内膜中层厚度（IMT）检测在冠心病中的诊断价值。 方法 选择2015年1月～2017年9月解放军第一一三医院住院治疗的134例冠心病患者作为观察组，其中观察组根据不同类型分为不稳定型心绞痛组44例，急性心肌梗死组49例及稳定型心绞痛组41例，另择同期50名健康体检者作为对照组。比较各组受试者血清可溶性E-选择素、GGT水平及IMT厚度，分析单一指标及联合指标检测的诊断效能。 结果 观察组血清可溶性E-选择素、GGT水平及IMT厚度均显著高于对照组，差异有统计学意义（P < 0.05）；不稳定型心绞痛组及心肌梗死组血清可溶性E-选择素、GGT水平及IMT厚度显著高于稳定型心绞痛组（P < 0.05）；不稳定型心绞痛组GGT水平显著高于心肌梗死组（P < 0.05）；3种指标联合诊断不稳定型心绞痛、心肌梗死、稳定型心绞痛及冠心病的阳性率分别为95.45%、97.95%、97.56%、97.01%，显著高于其他单一指标检测（P < 0.05）。 结论 血清可溶性E-选择素、GGT、IMT可能与冠心病发生、发展相关，临床上建议三者联合进行冠心病的诊断。

[关键词] 血清可溶性E-选择素；谷氨酰转肽酶；颈动脉内膜中层厚度；冠心病

[中图分类号] R541 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0046-04

[Abstract] Objective To investigate the value of serum soluble E-selectin and glutamyl transpeptidase （GGT） combined with carotid intima-media thickness （IMT） in the diagnosis of coronary heart disease. Methods A total of 134 patients with coronary heart disease who hospitalized in the 113rd Hospital of PLA from January 2016 to September 2017 were selected as the observation group. And according to different types the observation group was divided into subgroups， including 44 patients in unstable angina pectoris group， 49 patients in acute myocardial infarction group and 41 patients in stable angina pectoris group， and 50 healthy people that took physical examinotion in the same period were selected as the control group. Levels of serum soluble E-selectin， GGT and IMT were compared among the three groups， and the diagnostic efficiencies of single indicator and combined detection were analyzed respectively. Results The levels of serum soluble E-selectin， GGT and IMT in the observation group were significantly higher than those in the control group （P < 0.05）. Levels of serum soluble E-selectin， GGT and IMT in the unstable angina pectoris group and myocardial infarction group were significantly higher than those in stable angina pectoris group （P < 0.05）. GGT levels in the unstable angina pectoris group were significantly higher than those in the myocardial infarction group （P < 0.05）. The diagnosis positive rate of unstable angina pectoris， myocardial infarction， stable angina pectoris and coronary heart disease diagnosed by the combination of the three indicators were 95.45%， 97.95%， 97.56% and 97.01%， respectively， which were significantly higher than those of single indicator detection （P < 0.05）. Conclusion Serum soluble E-selectin， GGT and IMT may be related to the occurrence and development of coronary heart disease. The three indicators are suggested combined to diagnose coronary heart disease in clinic.

[Key words] Serum soluble E-selectin； Glutamyl transpeptidase； Carotid intima-media thickness； Coronary heart disease

冠心病是我国发病率、死亡率较高的疾病之一，寻找简便、有效、快速的检查方法筛查、预测冠心病是目前研究的热点问题[1]。冠心病的发病基础是冠状动脉粥样硬化。大量研究表明，炎性反应及氧化应激在冠心病的发生、发展中起重要作用[2-3]。血清可溶性E-选择素是机体炎性反应标志物之一，文献报道在人动脉粥样硬化斑块处，血清可溶性E-选择素表达有所增加，其可能与动脉病变程度相关[4]；血清γ-谷氨酰转肽酶（GGT）是一种细胞外分解代谢抗氧化谷胱甘肽的酶，近年来的研究表明，其活性可作为代谢综合征的检测指标，参与动脉粥样硬化进展[5]。本研究将血清可溶性E-选择素、GGT这两个实验室检测指标及颈动脉内膜中层厚度（IMT）相结合，探究联合诊断对冠心病的诊断价值，为临床早期冠心病的诊断提供新思路。……