中国人群CD40LG基因单核苷酸多态性对急性冠状动脉综合征影响的相关性研究

Soluble CD40L Levels Are Regulated by the-3459 A>G Polymorphism and Predict Acute Coronary Syndrome

目的新近的研究提示CD40/CD40L信号途径对急性冠状动脉综合征的发病及预后均具有一定影响。本研究旨在探讨CD40L G基因单核苷酸多态性与急性冠状动脉综合征患者冠状动脉病变程度间的关系。方法搜集2008年8月至2010年8月间在北京安贞医院抢救中心确诊为急性冠状动脉综合征的患者共482例,总结分析其临床特征、相关危险因素及血清单核细胞和血小板表达CD40水平以及CD40L G基因单核苷酸多态性对冠状动脉病变程度的影响。结果 (1)6.8%(n=33)的急性冠状动脉综合征患者未检测到血清sCD40L(<95 ng/L),449例患者平均血清sCD40L为296±25 ng/L,sCD40L平均水平男性为309 ng/L,女性为195 ng/L,男性高于女性(P<0.001),sCD40L水平随着冠状动脉病变程度加重而升高(P<0.001)。(2)不同基因型间血清sCD40L水平与冠状动脉评分存在显著性差异(P<0.001),趋势具有统计学意义。其中以GG基因型的sCD40L水平最高,为409ng/L,冠状动脉病变程度最严重(P<0.001)。(3)多因素分析显示,在矫正年龄、性别及高血脂、高血压、糖尿病等危险因素后,CD40L G基因多态性与冠状动脉病变程度密切相关,它们的OR值分别为1.00、1.32、3.41(P≤0.001)。结论急性冠状动脉综合征患者血清sCD40L水平及CD40L G基因多态性与冠状动脉病变程度密切相关,在急性冠状动脉综合征临床危险分层中,血清sCD40L水平及CD40L G基因多态性是一个不容忽视的方面。

Ahn Current evidence suggests the cluster of differentiation 40 and ligand （CD40/CD40L） pathway as a key process in the development, progression, and outcome of acute coronary syndrome （ACS）. The aim was to in- vestigate the prognostic importance of soluble CD40L （sCD40L） levels, single nucleotide polymorphisms （SNP） in the CD40LG gene, and the relation between sCD40L and SNPs in patients with ACS. Methods Samples were obtained on admission from 482 patients with ACS in Beijing Anzhen hospital. Results （ 1 ） In total, 6. 8% （n = 33 ） of the patients had undetectable （ 〈95 ng/L） sCD40L. The average level of sCD40L in 449 patients was 296 ±25 ng/L, the average level of sCD40L in male （309 ng/L） were higer than that in female （195 ng/L）, sCD40L levels were associated with the severity of ACS （ P 〈 0. 001 ）. （ 2 ） The distribution of cCD40L were different among SNP polymorphism of CD40LG, patients with GG genotype showed the highest level of sCD40L （ P 〈 0. 001 ）. （ 3 ） After adjustment of age, sex, and related risk factors, polymorphism of CD40LG was related significantly with the severity of ACS, ratio odds were 1.00, 1.32, 3.41 （P≤0. 001 ） respectively. Conclusion We identified a SNP in the CD40LG gene as a novel regulator of sCD40L plasma concentrations and a predictor of the severity of ACS.