不同糖耐量状态下急性冠脉综合征患者血清sCD40L水平和冠脉狭窄程度的相关性分析

The correlation of serum sCD40L level and coronary stenosis in acute coronary syndromes patients with different glucose tolerance conditions

目的探讨急性冠脉综合征患者在不同糖耐量状态下，血清可溶性CD40配体（sCD40L）水平与冠脉狭窄程度的相关性。方法入选急性冠脉综合征患者154例，根据OGTF试验结果分三组：糖耐量正常组（NGT）61例、糖耐量减低组（IGT）48例、2型糖尿病组（T2DM）45例，三组均于入院时即行酶联免疫吸附法（ELISA）检测血清sCD40L水平，并对其行冠脉造影，采用Gensini积分系统进行评分，比较各组患者sCD40L水平与冠脉狭窄程度的关系。结果三组患者中，糖耐量减低组[（41．8±19．8）分]和糖尿病组[（40．1±18．7）分]冠脉狭窄程度积分明显高于糖耐量正常组[（21．9±15．3）分]（P〈0．01）；糖尿病组与糖耐量减低组间冠脉狭窄程度积分比较差异无统计学意义（P〉0．05）；糖耐量减低组血清sCD40L水平[（2．46±0．79）ng／m1]高于糖耐量正常组[（2．12±0．81）ng／ml]（P〈0．05），糖尿病组[（2．57±0．68）ng／m1]明显高于糖耐量正常组（P〈0．01）；糖尿病组高于糖耐量减低组，但差异无统计学意义（P〉0．05）。三组患者血清可溶性sCD40L水平变化与冠状动脉狭窄程度无相关（r=-0．147，P〉0．05）。结论ACS患者在血糖轻度异常时CD40／CD40L即可过度激活，不一定血糖过高，即达到糖尿病状态时才有CD40／CD40L的激活；糖耐量异常的ACS患者中血清sCD40L水平与冠状动脉病变程度可能无相关。

Objective To explore the relationship between serum sCD40L level and coronary ste- nosis degree in acute coronary syndromes（ACS） patients with different glucose tolerance conditions. Methotis 154 patients with ACS were divided into normal glucose tolerance group （NGT） , impaired glucose tolerance group （IGT） and type 2 diabetes group （T2DM） according to the OGTT. The levels of serum sCD40L were detected by ELISA, and all patients underwent coronary angiography in order to calculate their Gensini score. Then the relationship between serum sCD40L level and coronary stenosis was analyzed by statistics. Results The Gensini scores of IGT[（41.8 ± 19.8）score] and T2DM groups [（40. 1 ±18.7） score ] were higher than NGT group [ （21.9 ± 15.3 ） score I （ P 〈 0. 01 ） , but there was no statistical difference between IGT and T2DM（ P 〉 0.05 ） group. The serum sCD40L levels of [GT [ （ 2.46 ± 0. 79 ） ng/ml ] were higher than NGT group [ （2. 12 ± 0. 81 ）ng/ml] （ P 〈 0. 05 ）, and the serum sCD40L levels in T2DM group [ （ 2. 57 ± 0. 68 ） ng/ml ] were obviously higher than NGT group [ （ 2. 12 ± 0. 81 ） ng/ml ] （ P 〈 0. 01 ）. The serum sCD40L levels in T2DM group were higher IGT group, but there was no statistical difference between T2DM and IGT groups（ P 〉 0. 05）. Statistical analysis revealed that serum sCD40L levels had no statistical difference among the three groups and it had no relationship with coronary stenosis （ r = -0. 147,P 〉 0.05）. Conclusions CD40/CID40L activation would occur in the patients of ACS with wildly abnormal blood sugar, not only in those who had diabetes with much higher blood sugar. The serum sCID40L level in the ACS patients with abnormal glucose tolerance had no relationship with the severity of coronary stenosis.