急性冠脉综合征患者高表达的CD40L和炎症因子相关性

The positive correlation between enhanced expression of CD40L and serum inflamnmtory factors in patients with acute coronary syndrome

目的检测急性冠脉综合征（ACS）患者CD4^＋T细胞CD40L的表达率、其血清可溶性CD40配体（sCD40L）和高敏C反应蛋白（hsCRP）、细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）的浓度，分析CD40L（sCD40L）与炎症因子的相关性，探讨CD40／CD40L在ACS发病中的作用及可能途径。方法采用前瞻性研究方法，选取2006-10-2007-4中山大学附属第一医院急诊科、心血管医学部冠心病患者32例，包括稳定性心绞痛（SAP）7例、不稳定性心绞痛（UAP）14例、急性心肌梗死（AMI）11例。正常对照组（CON）为与患者年龄、性别相匹配的健康志愿者8例。所有受试者均排除感染、肿瘤、风湿、肝肾功能不全，未使用类固醇和免疫抑制剂等。流式细胞分析术（FCM）检测CD4^＋T细胞表达CINOL的阳性细胞率，ELISA法检测血清sCD40L、ICAM-1和VCAM-1浓度，免疫比浊法检测血清hsCRP浓度。所有资料使用SPSS11．0进行统计学分析。结果AMI、UAP、SAP、CON组CD4^＋T细胞中表达CD40L的阳性细胞率（％）分别为8．60±3．02、3．24±1．13、2．18±1．80、0．59±0．18，AMI组显著高于其他3组（P〈0．05），UAP组亦显著高于CON组（P〈0．05）；4组血清sCD40L浓度分别为14．47±8．00、8．06±6．96、7．32±3．58、4．48±1．49（ng／mL），AMI组明显高于其他3组（P〈0．05）；4组血清hsCRP浓度分别为20．30±7．57、14．04±8．03、3．78±4．99、0．93±0．77（mg／L），AMI组显著高于其他3组（P〈0．05），UAP组亦显著高于SAP组与CON组（P〈0．05）；4组血清ICAM-1浓度分别为418．09±222．19、212．86±128．43、165．04±32．12、108．62±62．27（ng／mL），ANI组显著高于其他3组（均P〈0．05），UAP组亦高于CON组（P〈0．05）；4组血清VCAM-1浓度分别为5540．02±2614．65、3760．95±1915．01、4167．27±2084．48、2405．65±870．45（ng／mL），AMI组显著高于CON组（P〈0．01）；AMI组CD4^＋T细胞中表达CD40L的阳性细胞率与VCAM-1呈明显正相关性（r=0．730，P=0．011），其血清sCD40L与hsCRP、ICAM-1、VCAM-1呈明显正相关性（r=0．677，P=0．011；r=0．901，P=0．000；r=0．714，P=0．014）。结论急性冠脉综合征患者CIN^＋T细胞CINOL的表达率和血清sCINOL浓度升高，且与血清hsCRP、ICAN-1、VCAN-1呈明显正相关；在ACS发生中起作用，此和hsCRP、ICAN-1、VCAN-1等有关，而CD40L/sCINOL可望作为冠心病危险性的预测因子。

Objective To study the serum levels of sCD40L, hsCRP, ICAM-1 and VCAM-1, and the expression of CD40L of the CD4 ＋ T cells in patients withacute coronary syndrome （ACS）, and to explore the relationship between CD40L and inflammatory factors and the effects of CD40/CD40L on ACS. Method Thirty- two coronary heart disease patients without history of other discernible systemic disease and medicine of steroids or immunosuppressants taken were divided into acute myocardial infarction group （AMI, n = 11 ）, unstable angina pectoris group （USP, n = 14） and stable angina pectoris group （SAP, n = 7）. The control group was composed of eight healthy volunteers （ CON group）. Theexpression of C40L was determined by flow cytometry （FCM）. Senan sCD40L, ICAM-1 and VCAM-1 were determined by using ELISA. The serum hsCRP was assayed by using immunoturbidimetry. Data were analyzed with SPSS 11.0 software for windows. Results The expression percentage （ % ） of CD40L of the CD4^＋ T cells, and the serum levels of sCD40L, hsCRP, ICAM-1 and VCAM-1 were sifnificantly higher in patients of AMI group than those in patients of other groups （ P 〈 0.05 or P 〈 0.01 ）. Similarly, those biomarkers in patients of UAP group were usually higher than those in patients of CON or SAP groups （P 〈0.05）. There was a positive correlation between the expression of CD40L and the serum level of VCAM-1 in patients of AMI group （ P 〈 0.05）, and likewise, a positive correlation also existed between the serum level of sCD40L and other factors, hsCRP, ICAM-1 as well as VCAM-1, in patients of AMI group （ P 〈 0.05）. Conclusions The enhanced expression of CD40L of the CD4^＋ T cells and high serum level of sCD40L are present in patients with acute coronary syndrome. The hsCRP, ICAM-1 and VCAM-1 play roles in the pathogenesis of ACS, and they have correlation with enhanced expression of CD40L and high senan level of sCD40L. Therefore, CD40L and sCD40L may be used as indicators of risk in coronary heart disease.