单核细胞尿激酶型纤溶酶原激活物受体表达水平与冠状动脉粥样硬化斑块稳定性的关系

Relationship between urokinase plasminogen activator receptor expression level in monocytes and stability of coronary atherosclerotic plaque

目的探讨不同临床类型的冠状动脉粥样硬化性心脏病患者外周血单核细胞尿激酶型纤溶酶原激活物受体(uPAR)表达水平的差异及其在治疗前后的变化,并观察该指标与术后心血管事件的相关性。方法连续入选经冠状动脉造影证实的冠心病患者136例,其中包括急性冠脉综合征(ACS)85例、稳定型心绞痛(SAP)51例,另选20例健康志愿者作为对照。留取全血标本,用流式细胞仪检测各组患者外周血单核细胞uPAR的表达水平。观察ACS组经皮冠状动脉介入(PCI)治疗24,48h,3个月后外周血单核细胞uPAR表达水平的变化。随访ACS组患者2年,记录主要心血管事件的发生情况。结果 ACS组uPAR表达水平较SAP组及健康志愿者组均显著升高(P<0.01),ACS组PCI术后3个月的uPAR表达水平较术前有显著下降(P<0.01)。85例ACS患者平均随访(20.46±2.45)个月,术后发生主要心血管事件24例,事件组单核细胞uPAR表达水平显著高于无事件组(P<0.01)。应用多因素logistic回归分析发现,单核细胞上uPAR的表达水平与术后主要心血管事件显著相关(P<0.01)。结论 ACS患者单核细胞uPAR的表达水平较SAP患者显著升高,ACS患者uPAR的表达水平与主要心血管事件具有明显相关性,单核细胞uPAR的表达水平是冠心病临床病情严重程度的一个敏感指标,对于判断动脉粥样斑块的稳定性以及心血管疾病的预后有重要价值。

Objective To investigate the expression level of urokinase plasminogen activator receptor （uPAR） in monocytes in coronary heart disease （CHD） patients before and after percutaneous coronary intervention （PCI） and to determine the relationship between uPAR and major adverse cardiac events （MACE）.Methods A consecutive cohort of 136 CHD patients were enrolled,including 85 acute coronary syndrome （ACS） patients and 51 stable angina pectoris （SAP） patients.Twenty healthy volunteers were taken as control group.Peripheral blood samples were collected,and uPAR expression in monocytes was measured by flow cytometry at 24 h,48 h,and 3 months after PCI treatment.MACE were recorded during 2-year followe-up.Results Expression level of uPAR was significantly higher in ACS patients than in SAP patients and healthy controls（P0.01）.In ACS group,the expression level of uPAR decreased significantly at 3 months after PCI（P0.01）.Among 85 ACS patients who were followed up for an average of （20.46±2.45） months,24 MACE were reported.The expression level of uPAR in MACE group was significantly higher than that in non-MACE group（P0.01）.Ordinal logistic regression analysis revealed that the level of uPAR expression in monocytes was significantly correlated to MACE.Conclusion The level of uPAR expression in monocytes in ACS group is significantly higher than that in SAP group.Expression level of uPAR in ACS patients is significantly correlated to MACE.uPAR is a sensitive predictor for the severity of CHD,and is of great significance in evaluating the stability of atheromatous plaque and the outcome of CHD.