急性冠脉综合征患者辅助性T细胞亚群变化及意义

Significance of the change of T-helper type 1/2 in patients with acute coronary syndrome

目的 :探讨急性冠脉综合征 (ACS)患者外周血辅助性T淋巴 (Th)细胞亚群 1和亚群 2 (Th1/Th2 )的变化及意义。方法 :6 4例ACS患者 (其中急性心肌梗死 (AMI) 2 8例 ,不稳定心绞痛 (UA) 36例 )、18例稳定型心绞痛 (SA)、12例陈旧性心肌梗死 (OMI)、2 1例胸痛综合征 (CPS)患者和 2 3例对照 (C)外周血单个核细胞 (PBMC)经植物血凝素 (PHA)刺激培养后 ,应用酶联免疫吸附方法 (ELISA)检测培养液上清中干扰素γ(IFN γ)和白介素 4 (IL 4 )水平。结果 :ACS组培养液上清中IFN γ水平及IFN γ/IL 4比值明显高于SA组、OMI组、CPS组和C组 ,OMI组、SA组、CPS组与C组间无显著性差异 ;各组间IL 4水平无显著性差异。ACS患者培养液上清中IFN γ水平随发病时间的延长而逐渐下降 ,但AMI患者IFN γ高表达持续时间更长。结论 :ACS患者存在Th1/Th2功能失衡 ,主要表现为Th1细胞功能亢进 ,可能是ACS的发病机制之一 ;AMI患者Th1/Th2功能失衡可能参与了AMI后自身免疫因素引起的心肌损伤和心室重塑过程。

Objective:To study the significance of the change of T helper type 1/2 in patients with acute coronary syndrome.Methods:Peripheral blood mononuclear cells were collected from 64 patients with acute coronary syndrome (ACS,including 28 patients with acute myocardial infarction (AMI) and 36 patients with unstable angina (UA)),18 patients with stable angina (SA),12 patients with old myocardial infarction (OMI),21 patients with chest pain syndrome (CPS) and 23 control donors (C).After stimulated with PHA,the levels of IFN γ and IL 4 in culture supernarants were measured by ELISA.Results:The levels of IFN γ and the ratios of IFN γ/IL 4 in group ACS are significantly higher than those in group SA,group OMI,group CPS and group C,while there is no significant difference among group SA,group OMI,group CPS and group C.There is no significant difference on IL 4 levels between each group.The levels of IFN γ decrease along with the prolongation of the course of ACS,and the high IFN γ levels last longer in group AMI.Conclusion:The Th1/Th2 functional imbalance exists in patients with ACS.The up regulation of Th1 cell functions may be one of the mechanisms of the onset of ACS.Th1/Th2 functional imbalance in AMI patients might be related with the immune mediated myocardial injury and ventricular remodeling after AMI. [