急性冠脉综合征患者血小板-单核细胞聚集与相关细胞因子的关系

Relation of platelet-monocyte aggregates and its related cytokines in patient with acute coronary syndrome

目的研究血小板单核细胞聚集(PMAs)及其相关细胞因子表达与急性冠脉综合征的关系。方法采用流式细胞术同时测定74例急性冠脉综合征(ACS)患者、58例稳定性心绞痛(SAP)患者和46例冠造阴性患者血浆中IL6、IL8、MCP1、sCD40L、sP选择素水平和全血中血小板单核细胞聚集率(PMAs)。结果ACS患者各细胞因子和PMAs水平均显著高于SAP和冠造阴性患者(P<0.01);而IL8、sCD40L、sP选择素和CRP在SAP患者与冠造阴性患者间差异无显著性(P>0.05)。相关性分析显示,各细胞因子及CRP与PMAs均有良好的正相关性(P<0.01),其中IL6和sP选择素与PMAs相关性最高,相关系数r分别为0.484和0.481(P均小于0.001)。Logistic回归分析显示,IL6和PMAs对于ACS的OR值分别为1.024(95%CI1.010～1.039)和1.326(95%CI1.125～1.564)。结论血小板-单核细胞聚集形成、血小板的活化及其相关细胞因子的表达在急性冠脉综征发生和发展过程中起着重要的作用,检测PMAs和IL6水平可以反映冠心病患者冠脉内斑块的稳定性状态。

Objective To investigate the circulating levels of platelet-monocyte aggregates （PMAs） and its related eytokines in patients with acute coronary syndrome. Methods Seventy-four patients with acute coronary syndrome （ACS）, fifty-eight patients with stable angine poctofis （SAP） and 46 controls were selected and their plasma IL-6, IL-8, MCP-1, soluble CD40L, soluble P-seleetin were simultaneously measured by flow eytometry. Their PMAs were also measured by flow eytometry. Results The levels of IL-6, IL-8, MCP-1, soluble CD 40 L, soluble P-seleetin and CRP were significantly higher in ACS patients than in SAP patients and the control group. However, there were no significant differences in the levels of IL-8, sCD40L, sP-selectin and CRP between SAP patients and the eontrol group. Correlation analysis showed that high levels of IL-6, and sP-seleetin were siguifieantly eorrelated to PMAs, with eorrelation eoeffieients was 0.484 and 0.481 （ P 〈 0.01）, respeetively. The odds ratios （OR） for IL-6 and PMAs as risk factors for ACS were 1.024, 95% CI 1.010 -1.039 and 1.326, 95% CI 1.125 - 1.564, respeetively. Conclusion Elevated levels of PMAs formation and their related eytokines were responsible for the onset of unstable eoronary sydrome in ACS patients, and levels of IL-6 and PMAs may be used for monitoring and guiding early intervention of ACS patients.