妊娠相关血浆蛋白-A及肿瘤坏死因子-α在人冠状动脉粥样斑块的表达及与斑块稳定性的关系

Expression of pregnancy associate plasma protein-A and tumor necrosis factor-α in human atherosclerotic plaque and their relationship with the stability of atheromatons plaque

目的:研究妊娠相关血浆蛋白-A(PAPP-A)及肿瘤坏死因子-α(TNF-α)在人冠状动脉粥样斑块的表达及与斑块稳定性的关系。方法:从36例尸检标本中获得48个冠状动脉蜡块标本,其中急性心肌梗死15例,非急性心肌梗死的粥样硬化冠状动脉21例,由组织病理学分为稳定型(21个)和不稳定型(27个)斑块。采用免疫组织化学的方法测定巨噬细胞(CD68),平滑肌细胞(α-actin),PAPP-A及TNF-α在冠状动脉局部组织中的表达情况。结果:PAPP-A和TNF-α在血管内膜及中膜均有表达。PAPP-A在巨噬细胞及泡沫细胞处表达最明显。TNF-α阳性细胞见于斑块处的巨噬细胞、泡沫细胞、内皮细胞、平滑肌细胞及中膜平滑肌细胞胞浆。PAPP-A和TNF-α在不稳定型斑块内膜及中膜的表达均明显强于稳定型斑块(P<0.05)。在不稳定型斑块处内膜PAPP-A与TNF-α表达强度呈正相关(r=0.744,P<0.001)。结论:PAPP-A及TNF-α在冠状动脉粥样斑块局部有表达,在不稳定型斑块的表达明显高于稳定型斑块,与斑块的稳定性密切相关。PAPP-A在粥样斑块的表达与TNF-α呈正相关。

Objective：To investigate the expression levels of pregnancy associate plasma protein-A （PAPP A） and tumor necrosis factor α（TNF-α） in human atherosclerotic plaque and analyze the relationship between PAPP A and TNF-α with the stability of atherosclerotic plaque. Method： Forty eight specimens of human coronary artery atherosclerotic plaques were obtained from autopsy of 36 patients, 15 cases of ACS including acute myocardial in farction（AMI） and 2l cases of patients without myocardial infarction in this study. They were divided into stable/ fibrous and unstable/vulnerable groups histologically. Immunohistochemistry was used to detect the presence of macrophages（CD68）, smooth muscle cell（α- actin） and to examine the expression of PAPP-A and TNF-α. Result： The expression of PAPP-A and TNF-α were observed in intima and tuniea media. PAPP-A was found strongly in macrophage and foam cell. TNF-α staining was positive in the macrophage, foam cell, endothelial cell （EC） and smooth muscle cell （SMC） of atherosclerosis area and cytoplasm of SMC in tunica media. The expression of PAPP A and TNF-α in intima and tunica media of the unstable plaques were much stronger than in the stable ones （P〈0.05）. There was a positive correlation between the expression of PAPP-A and TNF -α in plaques（r= 0. 744, P=0. 000）. Conclusion： The expression of PAPP A, and TNF-α were observed in coronary arteries atherosclerotic lesion. The expression of them in the unstable plaques was significantly increased as compared to the stable ones. They are closely related with the stability of plaques and may participate in the formation of unstable plaque. There was a positive correlation between the expression of PAPP A and TNF-α in plaques.