妊娠相关血浆蛋白-A与OX40配体共同高表达在急性冠状动脉综合征中的临床意义

The clinical implications of increased coexpression of pregnancy associated plasma protein-A and OX40 ligand in patients with acute coronary syndromes

目的:探讨急性冠状动脉综合征(ACS)患者血清妊娠相关血浆蛋白-A(PAPP-A)水平与可溶性OX40配体(sOX40L)及单核细胞表达OX40L水平之间的相关性。方法:应用双抗夹心酶联免疫测定法(ELISA)分别对冠状动脉造影正常对照组(30例)、稳定型心绞痛(SA)组(60例)、不稳定型心绞痛(UA)组(50例)、急性心肌梗死(AMI)组(30例)患者血清PAPP-A及sOX40L水平进行检测,采用流式细胞术检测患者血单核细胞表达OX40L水平。结果:血清sOX40L、PAPP-A水平UA组[(15.7±4.9)μg/L,(25.4±6.8)mg/L]及AMI组[(17.1±5.3)μg/L,(26.3±5.6)mg/L]明显高于SA组[(3.4±1.4)μg/L,(9.6±2.1)mg/L]及对照组[(3.9±1.3)μg/L,(8.5±2.8)mg/L];循环血单核细胞表达OX40LUA组[(25.6±5.5)MFI]及AMI组[(29.4±6.3)MFI]明显较SA组[(10.6±2.8)MFI]及对照组[(11.1±3.5)MFI]高。ACS患者血清PAPP-A水平与sOX40L及单核细胞表达OX40L呈显著正相关(r1=0.54,r2=0.51;P<0.0001);ACS患者血清PAPP-A、sOX40L水平及单核细胞表达OX40L均与冠状动脉复杂狭窄程度呈正相关(r1=0.56,r2=0.55,r3=0.40;P<0.001)。结论:ACS患者血清PAPP-A水平与sOX40L及单核细胞表达OX40L相关,二者共同高表达提示冠状动脉斑块不稳定,可能是ACS活动性标志物。

Objective：To investigate whether PAPP-A level was related to serum OX40 ligand （OX40L） level or membrane-bound OX40L level in patients with ACS.Method：All patients underwent coronary angiography in our study.Overall,30 normal controls,60 patients with stable angina （SA） and 80 patients with acute coronary syndromes （ACS）,including unstable angina （UA） （n=50） and acute myocardial infarction （AMI） （n=30） were enrolled in current study.Serum PAPP-A and soluble OX40L （sOX40L） were measured by ELISA whereas the expression of OX40L on monocytes were analyzed with flow cytometry.Result：The expression of OX40L in peripheral monocytes in patients with UA [25.6±5.5 mean fluorescence intensity （MFI）] and AMI （29.4±6.3 MFI） were significantly higher than those in patients with SA （10.6±2.8 MFI） and controls （11.1±3.5 MFI） （P〈0.001）.Both sOX40L and PAPP-A in patients with UA （15.7± 4.9 μg/L,25.4±6.8 mg/L,respectively） and AMI （17.1±5.3 μg/L,26.3±5.6 mg/L,respectively） were significantly higher than those in patients with SA （3.4±1.4 μg/L,9.6±2.1 mg/L,respectively） and controls （3.9 ± 1.3 μg/L,8.5±2.8 mg/L,respectively） （P〈0.001）.It was interesting that a positive correlation was found between sOX40L,membrane-bound OX40L and serum PAPP-A levels （r1=0.54,r2=51;P〈0.0001）.PAPP-A levels,serum and membrane-bound OX40L were all significantly correlated with complex coronary stenosis（r1=0.40,r2=0.56,r3=0.55,P〈0.001）.Conclusion：PAPP-A level was related to OX40L in serum and membrane-bound in patients with ACS.Enhanced level of serum PAPP-A and sOX40L may represent markers for coronary disease activity.