尸检组织环氧合酶2、妊娠相关血浆蛋白A在冠状动脉的表达与急性冠状动脉综合征发生的关系

Expression of COX-2 and pregnancy associate plasma protein A in coronary arteries and their relationship with acute coronary syndrome： an autopsy study of 42 cases

目的 检测急性冠状动脉综合征（ACS）发生时尸检标本中环氧合酶2（COX-2）与妊娠相关血浆蛋白A（PAPP—A）在冠状动脉局部的表达情况及两者相关性。方法从2002—2007年尸检例中筛选出有ACS发生的21例标本作为ACS组，选择未发生ACS的标本21例作为对照组，分别取其左、右冠状动脉。以CD68标记巨噬细胞、α-肌动蛋白标记平滑肌细胞，通过对这两种细胞的标记定位PAPP-A、COX-2的阳性部位。结果（1）COX-2及PAPP—A的阳性部位均为内皮细胞胞质、巨噬细胞胞质、平滑肌细胞胞质。COX-2在ACS组平滑肌细胞胞质的表达阳性率为28．60％，在对照组平滑肌细胞胞质阳性率为4．76％，结果表明ACS组COX-2表达明显高于对照组（X2=14．13，P〈0．05）。（2）在ACS发生时，COX-2与PAPP—A在冠状动脉中膜平滑肌的表达有明显的相关性（r=0．88，P〈0．05）。（3）非斑块处平滑肌表达PAPP-A强度明显强于斑块底部平滑肌（X^2=10．36，P〈0．05）。结论COX-2、PAPP—A可通过在冠状动脉局部发挥作用来参与ACS的发生。

Objective To study the expression of COX-2 and pregnancy associate plasma protein A （PAPP-A） in coronary arteries and their relationship with acute coronary syndrome. Methods Twenty-one autopsy cases with acute coronary syndrome encountered during the period from 2002 to 2007 were enrolled into the study. Another 21 autopsy cases without evidence of acute coronary syndrome were used as the controls. The right and left coronary arteries of each group were dissected, embedded and processed as paraffin sections. Immunohistochemical study for CD68 and α-actin was performed to highlight the presence of macrophages and smooth muscle cells, respectively. The expression of COX-2 and PAPP-A was evaluated. Results In the acute coronary syndrome group, COX-2 was localized mainly in the cytoplasm of endothelial cells, macrophages and smooth muscle cells. COX-2 expression in the cytoplasm of smooth muscle cells （28.60%） was significantly higher than that in the control group （4.76% ,X^2 = 14. 13, P 〈 0. 05 ）. There was a positive correlation on COX-2 and PAPP-A expression in smooth muscle cells of the media layer of coronary arteries in acute coronary syndrome group （r = 0. 88, P 〈 0. 05 ）. The expression of PAPP-A in smooth muscle cells of the media layer in coronary arteries not associated with plaque formation, was higher than that when there were atherosclerotic plaques （X^2 = 10. 36, P 〈 0. 05 ）. Conclusion In coronary arteries, COX-2 and PAPP-A play certain roles in the pathogenesis of acute coronary syndrome.