整合素β在肺动脉血栓栓塞症患者中的变化及在诊疗中的作用
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摘要
目的明确T细胞免疫失衡在肺动脉血栓栓塞症(PE)发生发展中的作用,探讨整合素β1、β2和β3在PE中的变化和作用。方法选取在同济大学附属同济医院住院的PE患者70例为观察组,另选取汉族对照者30例对照组。所有入选者均行下列检测:NYHA心功能分级,血生化指标,D-二聚体,B型钠尿肽前体(pro-BNP),心电图,X线胸片,超声心动图,肺通气/灌注扫描或肺血管CT等检查。并通过流式细胞仪测定全血整合素β1、整合素β2、整合素β3水平。结果 PE患者组D-二聚体、肌钙蛋白、pro-BNP水平及整合素β1、β2、β3水平均显著高于对照组(P<0.05);整合素β1、β3与NYHA分级、肺血管CT、肌钙蛋白、proBNP及D-二聚体呈正相关(r>0,P<0.05)。整合素β2与NYHA、proBNP呈正相关(r>0,P<0.05),与肺血管CT、肌钙蛋白及D-二聚体无相关性(r>0,P>0.05)。结论整合素β1、β2及β3与PE各项临床指标之间存在相关性,可能参与肺动脉血栓的形成,可作为PE临床诊治的检测指标。
Objective To define the role of Integrin β expression among patients with PE and provide new thought of diagnosis and treatment, according to T cell imbalance playing a role in the development of pulmonary thromboembolism(PTE, abbreviated as PE). Methods A total of 70 patients with PE hospitalized in Tongji Hospital affiliated to Shanghai Tongji University and 30 control subjects were included. Tests including NYHA classification, serum biochemical index, D-dimer, electrocardiogram, chest radiograph, echocardiography, pulmonary ventilation/perfusion imaging or CT pulmonary angiography were conducted in all subjects. Integrin β1, β2 and β3 were evaluated by flow cytometer(FCM). Results The levels of D-dimer, troponin, pro-BNP and integrin beta 1, beta 2 and beta 3 in PE group were significantly higher than those in control group(P<0.05). Integrin beta 1 and beta 3 were positively correlated with NYHA classification, pulmonary vascular CT, troponin, proBNP and D-dimer(r>0, P<0.05). Integrin beta 2 was positively correlated with NYHA and proBNP(r>0, P<0.05), but not with pulmonary vascular CT, troponin and D-dimer(r>0, P>0.05). Conclusion Integrin beta 1, beta 2 and beta 3 are correlated with the clinical indexes of PE, which may be involved in the formation of pulmonary thrombosis, and can be used as the detection index of clinical diagnosis and treatment of PE.
Objective To define the role of Integrin β expression among patients with PE and provide new thought of diagnosis and treatment, according to T cell imbalance playing a role in the development of pulmonary thromboembolism(PTE, abbreviated as PE). Methods A total of 70 patients with PE hospitalized in Tongji Hospital affiliated to Shanghai Tongji University and 30 control subjects were included. Tests including NYHA classification, serum biochemical index, D-dimer, electrocardiogram, chest radiograph, echocardiography, pulmonary ventilation/perfusion imaging or CT pulmonary angiography were conducted in all subjects. Integrin β1, β2 and β3 were evaluated by flow cytometer(FCM). Results The levels of D-dimer, troponin, pro-BNP and integrin beta 1, beta 2 and beta 3 in PE group were significantly higher than those in control group(P<0.05). Integrin beta 1 and beta 3 were positively correlated with NYHA classification, pulmonary vascular CT, troponin, proBNP and D-dimer(r>0, P<0.05). Integrin beta 2 was positively correlated with NYHA and proBNP(r>0, P<0.05), but not with pulmonary vascular CT, troponin and D-dimer(r>0, P>0.05). Conclusion Integrin beta 1, beta 2 and beta 3 are correlated with the clinical indexes of PE, which may be involved in the formation of pulmonary thrombosis, and can be used as the detection index of clinical diagnosis and treatment of PE.
引文
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[2]虞宇楠,周琳,沈玉琴,等.肺动脉血栓栓塞症患者的免疫学变化及在诊疗中作用[J].临床心血管病杂志,2016,32(9):943-947.
[3]Wang LM,Duan QL,Yang F,et al.Activation of circulated immune cells and inflammatory immune adherence are involved in the whole process of acute venous thrombosis[J].Int J Clin Exp Med,2014,7(3):566-572.
[4]Konstantinides SV,Torbicki A,Agnelli G,et.al.2014ESC Guidelines on the diagnosis and management of acute pulmonary embolism[J].Eur Heart J,2014,35(43):3033-69.
[5]宋浩明,龚朱,王乐民,等.静脉血栓栓塞症患者外周血单个核细胞T细胞免疫功能相关基因mRNA[J].中华内科杂志,2012,71(7):551-553.
[6]Wang H,Wang C,Zhang L,et.al.Analysis of the protein-protein interaction networeks of differentially expressed genens in pulmonary embolism[J].Mol Med Rep,2015,11(4):2527-2533.
[7]Wang H,Duan QL,Wang LM,et.al.Analysis on the pathogenesis of symptomatic pulmonary embolism with human genomics[J].Int J Med Sci,2012,9(5):380-386.
[8]Lv W,Wang LM,Duan QL.et.al.Characteristics of the complement system gene expression deficiency in patient with symptomatic pulmonary embolism[J].Thromb Res,2013,132(1):e52-57.
[9]Lv W,Duan QL,Wang LM,et.al.Gene expression levels of cytokines in peripheral blood mononuclear cells from patients with pulmonary embolism[J].Mol Med Rep,2013,7(4):1245-1250.
[10]Duan QL,Lv W,Wang LM,et.al.mRNA expression of interleukins and Th1/Th2imbalance in patients with pulmonary embolism[J].Mol Med Rep,2013,7(1):332-336.
[11]Lv W,Duan QL,Wang LM,et.al.Expression of b cell related genes in peripheral blood mononuclear cells of patients with symptomatic pulmonary embolism[J].Mol Med Rep,2015,11(3):2299-2305.
[12]王乐民.症状性静脉血栓形成机制的假说[J].内科急危重症杂志,2013,19(5),257-260.