可溶性CD40L在冠心病患者血清中的检测意义

Serum Soluble CD40L Level and its Application in Coronary Heart Disease

目的观察不同类型冠心病患者血清中可溶性CD40配体(sCD40L)变化,并探讨其水平与急性冠脉综合征的斑块稳定性是否有关以及与血脂各组分及冠脉狭窄程度的关系.方法采用酶联免疫吸附法测定64例冠心病患者(急性心肌梗死组18例,不稳定型心绞痛组19例,稳定型心绞痛组27例)及20名正常对照者血清sCD40L浓度.29例冠心病患者冠脉狭窄程度的造影结果.结果急性冠脉综合征患者sCD40L水平〔急性心肌梗死组和不稳定心绞痛组分别为(19.8±3.0)、(19.6±4.3)ng/mL〕,显著高于稳定型心绞痛〔(8.3±3.2)ng/mL,P<0.05〕和正常对照组〔(2.6±1.9)ng/mL,P<0.05〕,而在稳定型心绞痛组与正常组间差异无显著性;sCD40L水平与高密度脂蛋白胆固醇呈负相关(r=?0.301,P<0.05),与冠脉狭窄程度呈正比(r=0.48,P<0.01).结论急性冠脉综合征患者外周血sCD40L水平明显升高,这可能与急性冠脉综合征的发生有关,且可作为动脉粥样硬化斑块不稳定的一个重要标志.冠脉狭窄严重程度与sCD40L水平成正比,抑制sCD40L水平有望成为治疗再狭窄的重要方法.

Objective To investigate the serum of soluble CD40 ligand （sCD40L） in coronary heart disease and its relationship with serum lipid levels and the extent of coronary stenosis, whether upregulation of CD40L system is related to stability of atherosclerotic plaque in patients with acute coronary syndrome. Methods Enzyme - linked immunosorbent assay （ELISA） was used to measure the level of sCD40L in 64 patients with coronary heart disease （ 18 with acute myocardial infarction, 19 with unstable angina pectoris and the other 27 with stable angina peetoris ） and 20 matched heahhy controls. Coronary stenosis of 29 patients were assessed by angiographic coronary stenosis morphology. Results sCD40L level was significantly higher in patients with acute coronary syndrome （ACS） [ （ 19.8±3.0 ）, （ 19.6 ± 4. 3 ） ng/mL in acute myocardial infarction and unstable angina pectoris group, respectively ] than that of those with stable coronary heart disease and that of controis [ （ 8.3 ±3.2 ） ng/mL and （2.6 ± 1.9 ） ng/mL, respectively P 〈 0. 05 ] . Serum sCD40L level was neg- atively related to HDL-C （ r = -0. 301, P 〈0. 05）, and positively related to coronary stenosis （ r =0.48, P 〈0.01 ） . Conclution The levels of sCD40L increase in acute coronary syndrome, which may be related to the pathogenesis of ACS, and can be used as a potential marker of plaque instability, which is positively to the extent of coronary stenosis, inhibitor of CD40L can be used as a important method to heal restenosis,