不稳定心绞痛患者血清sCD40L、GMP-140的检测及氯吡格雷的干预研究

Levels of serum soluble CD40 ligand and GMP-140 in unstable angina and the influence of clopidogrel

目的观察不稳定心绞痛(UA)患者血清可溶性CD40配体(sCD40L)、GMP-140的变化及氯吡格雷的干预影响和临床疗效。探讨sCD40L与GMP-140关系,在UA发生、发展中作用及氯吡格雷的抑制炎症反应作用。方法59例UA患者随机分为常规治疗组29例,氯吡格雷组(在常规治疗基础上加用氯吡格雷首次顿服300mg,次日起每天75mg,连服2周)30例。另选正常对照组(无任何治疗)20例。采用酶联免疫吸附法(ELISA)测定59例UA患者治疗前后及20例正常对照者血清sCD40L、GMP-140浓度,并观察氯吡格雷的临床疗效。结果UA患者血清sCD40L、GMP-140的水平显著高于正常对照组(P<0.01)。治疗后氯吡格雷组和常规治疗组血清sCD40L、GMP-140水平均显著下降(P<0.01),且氯吡格雷组下降水平优于常规治疗组(P<0.05,P<0.01)。氯吡格雷组临床总有效率优于常规治疗组(P<0.05)。结论sCD40L可刺激GMP-140表达,可作为动脉粥样硬化(AS)癍块不稳定的标志。氯吡格雷可减轻AS的免疫炎症反应,稳定癍块。

Objective To observe levels of serum soluble CD40 ligand（sCD40L） and GMP-140 in unstable anigna and the influence of clopidogrel and the clinical effect of clopidogrel.To explore the relationship between sCD40L and GMP-140 and the effect of sCD40L in unstable angigna.Clopigdorel may inhibit the inflammation of atherosclerosis.Methods 59 patients with unstable angina were divided randomly into usual therapy group（29 patients） and clopidogrel group（usual therapy plus clopidogrel loading dose of 300mg orally and then 75mg daildy for two weeks,30 patients）.In addition,20 healthy subjects were chosen as healthy control group.Enzyme-linked immynosorbent assay was used to measued levels of sCD40L and GMP-140 in 59 unstable angina patients before and after treatment and in 20 healthy persons,the clinical efficiency of clopidogrel was observed.Results Levels of sCD40L and GMP-140 were significantly higher in unstable angina（P〈0.01）.After treatment,levels of sCD40L and GMP-140 were significantly decreased in both groups,but the clopidogrel group was more significant than therapy group（P〈0.05,P〈0.01）.The total effective rate of clopidogrel group was better than therapy group（P〈0.05）.Conclusion sCD40L can stimulate GMP-140 expression and can be used as a marker of plague instability.Clopidogrel can reduce the inflammatory reaction and stabilize plague.