高脂血症血瘀证患者血浆可溶性CD40配体水平及其临床意义

Changes of Soluble CD40 Ligand in Patients with Hyperlipidemia of Blood Stasis Syndrome and Its Clinical Significance

目的观察高脂血症血瘀证患者体内血浆可溶性CD40配体(sCD40L)水平的变化及其与血瘀证证候积分、P-选择素、高敏C反应蛋白(hs-CRP)等之间的关系,了解血小板活化状态及炎症在高脂血症血瘀证病理生理过程中的作用,探讨血瘀证的致病机制。方法 高脂血症患者70例,分为血瘀证组39例,非血瘀证组31例。同时选30名正常健康体检者为对照组。对所有受试者进行主要理化检查指标以及sCD40L、P-选择素、hs-CRP等测定,分析各组上述指标间的相互关系。结果 高脂血症血瘀证组血瘀证证候积分显著高于对照组及非血瘀证组。血瘀证组和非血瘀证组P-选择素分别为(25.13±5.49)ng/L、(21.37±3.56)ng/L,sCD40L分别为(2.45±0.48)ng/L、(2.07±0.41)ng/L;均高于对照组[(14.91±2.48)ng/L、(1.63±0.25)ng/L](P<0.01);且血瘀证组P-选择素、sCD40L高于非血瘀组(P<0.01)。高脂血症患者血浆sCD40L与低密度脂蛋白胆固醇(LDL-C)呈正相关,相关系数为0.503(P<0.01),与P-选择素变化亦呈正相关,相关系数为0.897(P<0.01),与血瘀证量化的证候积分呈正相关,相关系数为0.603(P<0.01)。结论 高脂血症血瘀证患者体内sCD40L表达增高,表明血瘀证患者体内存在持续的炎症状态,血瘀证进一步加剧高脂血症慢性炎症的进程。

Objective To observe changes of soluble CD40 ligand（sCD40L） in patients with hyperlipidemia of blood stasis syndrome and its correlation with blood stasis syndrome integral,P-selectin,and high sensitive creatine reactive protein（hs-CRP）,to investigate the roles of platelet activation and inflammation in the physiopathologic process of blood-stasis type hyperlipidemia,and to explore the pathogenetic mechanism of blood-stasis syndrome（BSS）.Methods Seventy hyperlipidemia patients were assigned to two groups,39 in the BSS group and 31 in the non-BSS group.Meanwhile,thirty healthy subjects were grouped as the control.Main physiochemical indices,blood levels of sCD40L,P-selectin,hs-CRP were detected in all.The correlations of the aforesaid indices were analyzed.Results BSS score in the BSS group was higher than that in the non-BSS group and in the control group.Higher blood levels of P-selectin and sCD40L were shown in the BSS group than in the non-BSS group [（25.13±5.49） ng/L vs（21.37±3.56） ng/L and（2.45±0.48） ng/L vs（2.07±0.41） ng/L] respectively,and the two indices were higher in hyperlipidemia patients than in healthy persons [（14.91±2.48） ng/L and（1.63±0.25） ng/L,P0.01].Correlation analysis showed that in patients with hyperlipidemia,blood level of sCD40L was positively correlated with low-density lipoprotein cholesterol（LDL-C） level（r=0.503,P0.01）,P-selectin（r=0.897,P0.01）,and the BSS score（r=0.603,P0.01）.Conclusions The over-expressed sCD40L indicated persistent inflammatory state in patients with hyperlipidemia of BSS.BSS would further accelarate the chronic inflammation process of hyperlipidemia.