血清可溶性Fas及炎性因子与冠心病不同表型的临床相关性研究

RESEARCH ON CLINICAL CORRELATION BETWEEN SERUM SOLUBLE FAS,INFLAMMATORY FACTORS AND DIFFERENT TYPES OF CORONARY HEART DISEASE

目的探讨血清可溶性Fas(soluble Fas,sFas)、TNF-α和IL-6水平与冠心病不同表型以及冠状动脉病变程度之间的关系。方法应用ELISA法测定了30例急性心肌梗死(AMI)、13例不稳定型心绞痛(UAP)、14例稳定型心绞痛(SAP)患者和23例正常对照组血清sFas、TNF-α和IL-6水平。所有心绞痛患者、正常对照组和部分AMI患者行冠状动脉造影术。比较冠状动脉不同狭窄程度患者血清sFas、TNF-α和IL-6水平与对照组比较。将病变受累血管不同支数的患者Gensini积分、血清sFas、TNF-α和IL-6水平与对照组比较。结果AMI组和UAP组血清sFas水平明显高于对照组和SAP组(P<0.01);AMI组和UAP组TNF-α水平高于对照组(P<0.05);UAP组IL-6水平均高于对照组和SAP组(P<0.05),AMI组IL-6水平也明显高于对照组及SAP组(P<0.01)。sFasI、L-6与TNF-α水平存在显著的正相关(r=0.289,0.271;P<0.05)。冠状动脉狭窄程度中度组和重度组sFas、TNF-α、IL-6水平高于对照组和轻度组(P<0.01或0.05)。双支病变组和多支病变组Gensini积分明显高于单支病变组(P<0.01);单支病变组血清sFas水平高于对照组(P<0.05),双支病变组sFas、TNF-α和IL-6水平均高于对照组(P<0.01或0.05);多支病变组TNF-α水平高于对照组(P<0.05)。结论不同表型的冠心病患者血清sFas、TNF-α和IL-6水平呈现显著性差异,高水平的sFas、TNF-α和IL-6可能与冠心病的发生与发展有关,特别是在ACS的过程中扮演重要角色。免疫因素和炎性因素共同参与冠状动脉粥样硬化斑块的发生、发展以及粥样斑块破裂过程中,二者之间可能存在有交叉反应现象。

Objective To evaluate the relationship between serum levels of souble Fas（sFas）, TNF-α, IL-6 and different clinical types of coronary heart disease （CHD） and the severity of coronary lesions. Methods By enzyme-linked immunomrbent assay （ELISA）, serum levels of sFas, TNF-α and IL-6 were measured from 30 patients with acute myocardiac infarction（AMI）, 13 patients with unstable angina pectoris（UAP）, 14 patients with stable angina pectoris（SAP） and 23 subjects as controls. The patients with angina pectoris（AP）, the control group and mine patients with AMI underwent coronary angioplasty （CAG）. The gensini score of artery stenosis and the serum levels of sFas, TNF-α and IL-6 were compared with those of 23 controls respectively. Results Significant increase in the concentrations of sFas were found in the serum from patients with AMI and UAP relative to those SAP and controls （ P 〈0.01 ）. Mean level of TNF-α was significantly higher in patients with AMI and UAP than those in controls （ P 〈 0.05）. The serum levels of IL-6 were increased in patients with UAP compared to the patients with SAP or controls （ P 〈 0.05 ）. The level of IL-6 in patients with AMI was also higher than that in patients with SAP and control group （ P 〈 0.01 ）. Moreover, in patients with CHD, sFas and TNF-a were positively correlated （ r = 0.289, P ---0.029）. IL-6 and TNF-a were also positively correlated in patients with CHD（ r = 0.271, P = 0.042）. Serum levels of sFas were higher in the severe and moderate groups than those in the control group （ P 〈 0.01 ）. Serum levels of sFas were higher in the moderate groups than those in the minor group （ P 〈 0.05）. Serum levels of TNF-α were higher in the severe and moderate groups than those in the control and minor groups（ P 〈 0.05 ）. Serum levels of IL-6 were higher in the severe and moderate groups than those in the controls （ P 〈0.01, P 〈0.05） ,and these groups were also higher than that in minor group （ P d0.05）. Double ramus group and multitude ramus group were higher than single ramus group in Gensini score. The level of sFas in single ramus group was higher than that in control group （ P 〈 0.05）. The levels of sFas,TNF-a and IL-6 in double ramus group were higher than those in the control group （ P 〈0.01, P 〈0.05, P 〈0.01）. The level of TNF-a in multitude ramus group was also higher than those in control group（ P 〈 0.05）. Conclusion High levels of sFas, TNF-a and IL-6 were significantly correlated with CHD, especially in the occurrence of ACS. The immune reaction and inflammatory response may play an impor- tant role in the development of vulnerable atherosclerotic plaque. The interaction may exist in the development.