急性冠脉综合征患者外周血单核细胞TLR4表达及其与TNF-α、hs-CRP的相关性研究

Relationship between expression of toll-like receptor 4 in peripheral blood monocytes and TNF-α and hs-CRP in patients with acute coronary syndromes

目的:探讨急性冠脉综合征(ACS)患者外周血单核细胞Toll样受体4(TLR4)表达及其与肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hs-CRP)的相关性及其临床意义。方法:研究对象124例,其中不稳定性心绞痛(UAP)42例,急性心肌梗死(AM I)28例,稳定性心绞痛(SAP)22例,正常对照组(Control)32例,比较各组间TLR4、TNF-α、hs-CRP表达差异。采用流式细胞术检测外周血单核细胞TLR4表达,酶联免疫吸附方法(ELISA)检测TNF-α,免疫比浊法检测hs-CRP水平。结果:Control组、SAP组、UAP组与AM I组外周血单核细胞TLR4的表达和血清TNF-α、hs-CRP水平依次增高;AM I组和UAP组TLR4表达及TNF-α、hs-CRP水平均显著高于SAP组和Control组(P<0.05);而AM I组与UAP组之间、SAP组与对照组之间TLR4表达和TNF-α、hs-CRP水平差异无显著性(P>0.05);TLR4与TNF-α和hsCRP呈正相关(P<0.05)。结论:ACS患者TLR4表达上调,促进炎症前体细胞因子(TNF-α)的分泌,从而提示TLR4及其介导的炎性反应与冠心病的发生、发展存在一定相关性;联合检测冠心病患者TLR4表达与TNF-α和hs-CRP水平,可作为易损斑块的预警指标之一。

Objective： To investigate the expression of toll- like receptor 4 （TLR4） in peripheral blood monocytes in patients with acute coronary syndromes, and to explore the relationship between TLR4 expression and the levels of tumor necrosis factor - alpha （ TNF - α） and high - sensitivity C - reactive protein （ hs - CRP）. Methods： The expressions of TLR4 in peripheral blood monocytes from 32 controls, 22 patients with stable angina pectoris （ SAP）, 42 patients with unstable angina pectoris （ UAP）, and 28 patients with acute myocardial infarction （AMI） were detected with flow cytometry. The concentration of TNF - α in serum was measured by enzyme linked immunosorbent assay （ELISA） , while the hs -CRP was analyzed by immunoturbidimetry. Results：Compared with control and SAP groups, the expressions of TLR4 and the levels of TNF - α and hs - CRP were significantly increased in UAP and AMI groups （ P 〈 0.05 ）. There was a positive correlation between the expression level of TLR4 and the levels of TNF - α and hs - CRP in patients with UAP and AMI. Conclusion： Acute coronary syndrome may be associated with overexpression of TLR4 in peripheral blood monocytes, and the expression of TLR4 in peripheral blood monocytes and serum TNF - α and hs - CRP levels may be effective markers of the vulnerable plaque in patients with coronary arteriosclerosis disease.