急性冠脉综合征中CD40L和基质金属蛋白酶致病作用的研究

Role of CD40L and matrix metalloproteinses in pathogenesis of acute coronary syndrome

目的探讨CD40L和基质金属蛋白酶(MMP)在冠脉斑块形成中的作用机制。方法对59例冠状动脉造影证实,有冠状动脉狭窄的急性冠脉综合症患者(男31例,女28例,平均年龄60·3岁),分为不稳定型心绞痛组(n=32)、急性心肌梗死组(n=27),同时设正常对照组(体检健康者,n=30)。采用ELISA法检测血清CD40L、C反应性蛋白(CRP)、MMP-2和MMP-9的水平。结果与正常对照组比较,血清CD40L、CRP、MMP-2和MMP-9的水平,随病情的加重而升高且差异显著(P<0·01),多支病变者的水平高于单支病变者。血清MMP-2与MMP-9的水平、CD40L与MMP-9的水平均呈正相关(r值分别为0·71和0·78)。结论血清MMP-2和MMP-9水平的增高与冠脉斑块的形成有一定的联系。CD40L可能是通过MMP-s引起冠脉损伤,从而导致斑块形成和冠心病的发生发展。

AIM To explore the role of serum CD40L and matrix metalloproteinses （MMP-s） levels in coronary plague formation. METHODS Fifty-nine （31 men and 28 women, mean age 60. 3 years） acute coronary syndrome patients with coronary stenosis confirmed by coronary arteriography were divided into acute myocardial infarction （AMI） group （ n = 27） and unstable angina pectoris （UAP） group （ n = 32）, and a normal control group （n = 30） was set up. The levels of serum CD40L, MMP-2 and MMP-9 were detected by ELISA. RESULTS Compared with those in normal control group, the levels of serum CD40L, MMP-2 and MMP-9 were significantly elevated along with exacerbation of the disease （P 〈 0. 01 ） and the levels of serum CD40L, MMP-2 and MMP-9 in the patients with multiple coronary lesions were higher than those in the patients with single coronary lesion. The levels of serum CD40L, MMP-2 and MMP-9 were positively correlated with that of CD40L （r = 0. 71 and 0.78, respectively）. CONCLUSION The elevation of serum CD40L, MMP-2 and MMP-9 levels are to some extent related to the coronary plague formation. CD40L may cause coronary lesion by way of MMP-s, thus leading to the coronary plague formation and the development of coronary diseases.