冠心病患者抗凝、纤溶功能及单核细胞上CD 40-CD 40L系统表达的研究

Study on Anticoagulant-Fibrinolytic Function and Expression of CD 40-CD 40 Ligand System on Monocytes in Patients with Coronary Heart Disease

目的观察冠心病(CHD)患者抗凝、纤溶功能及单核细胞上CD40-CD40L系统表达情况以及两者间的相关性。方法将36例CHD病例分为2组:心绞痛(SA)组和冠脉综合征(ACS)组,分别检测血浆中PC活性、D-dimer(D-D)、tPA、PAI-1含量、游离型配体sCD40L浓度和外周血单核细胞上CD40、CD40L表达水平,并与19例正常对照组相比较。结果ACS组、SA组患者血浆PC活性明显低于健康对照组;ACS组、SA组患者血浆D-D含量明显高于健康对照组;ACS组、SA组患者血浆tPA含量明显高于健康对照组;ACS组患者血浆PAI-1含量明显高于SA组、健康对照组;ACS组患者外周血单核细胞上CD40的表达水平明显高于SA组、健康对照组;ACS组、SA组患者血浆sCD40L浓度明显高于健康对照组(P<0.05);外周血单核细胞CD40与CD40L表达水平与血浆sCD40L浓度三者间进行Pearson相关系数分析,结果显示外周血单核细胞CD40与CD40L表达水平呈正相关(r=0.41,P=0.002);外周血单核细胞CD40表达水平与血浆sCD40L浓度呈正相关(r=0.367,P=0.006);血浆PAI-1含量与外周血单核细胞CD40表达水平、血浆sCD40L浓度呈正相关(r=0.328,P=0.014;r=0.401,P=0.002)。结论CHD患者抗凝、纤溶功能对评估CHD的预后、指导治疗有一定的价值。CD40-CD40L通路可能与ACS的形成有关,阻断CD40-CD40L信号途径可能成为防治AS的一个重要靶点。

Objective To investigate anticoagulant-fibrinolytic function and expression of CD 40-CD 40 ligand system on monocytes and the correlation between two system in patients with coronary heart disease. Methods 36 CHD patients was divided two groups：stable angina（SA）, acute coronary syndrome （ACS）. （CHD） In these patients, activity of plasma PC, contents of plasma D- dimer（ D- D）, tPA and PAI- 1 ,concentrates of plasma soluble CD 40 ligand （sCD 40L） , the expression level of CD 40 and CD 40L on peripheral blood mononnclear cells（ PBMC）, was detected, and was compared with 19 health adult. Results The activity of plasma PC in patients with CHD was significantly lower than healthy controls. The contents of plasma D- D in patients with CHD was significantly higher than healthy controls. The contents of plasma tPA in patients with CHD was significantly higher than healthy controls. The contents of plasma .PAI-1 in patients with ACS was significantly higher than patients with SA and healthy controls. The expression of CD 40 on PBMC in patients with ACS was significantly higher than patients with SA and healthy controls. The concentrates of plasma sCD 40L in patients with CHD was significantly higher than healthy controls （ P 〈 0.05 ）. There was positive correlation of the expression of between CD 40 and CD 40L on monoeytes in peripheral blood（r =0. 41 ,P =0. 002）;there was positive correlation between the expression of CD 40 on monocytes in peripheral blood and concentrations of sCD 40L in plasma（ r = 0. 367, P = 0. 006） ;there was positive correlation between the contents of plasma PAI- 1 and the expression of CD 40 on monocytes in peripheral blood,concentrations of sCD 40L in plasma（r =0. 328 ,P =0. 014; r =0. 401 ,P =0. 002）. Conclusion Study of the anticoagulant- fibrinolytie function in CHD patients had a certain value to assess prognosis and guide treatment of CHD. CD 40 - CD 40L pathway may correlate with the formation of ACS, blockade of CD 40- CD 40L system may be an important target for prevention and cure of AS.