OX40L对非ST段抬高性急性冠状动脉综合征再缺血事件的预测

Prognostic value of OX40L expression in NSTEACS patients in recurrent ischaemic events

目的:探讨非ST段抬高性急性冠状动脉综合征(ACS)患者外周血淋巴细胞表达OX40L及血浆可溶性OX40L(sOX40L)水平与再发缺血事件的关系。方法:选取我院336例非ST段抬高性ACS住院患者,收集患者基线资料及180d内发生急性心肌梗死(AMI)及因ACS再住院情况,对患者入院时血淋巴细胞表达OX40L、血浆sOX40L水平、高敏C反应蛋白(hs-CRP)水平进行检测;分析OX40L在淋巴细胞上的表达、血浆OX40L水平与再发缺血事件的关系并与CRP及预后的关系相比较。结果:外周血淋巴细胞OX40L高表达水平者随访30d(P<0.05)、高hs-CRP水平者30d(P<0.05)再缺血事件发生率高,Kaplan-Meier生存分析显示,较高淋巴细胞OX40L表达对30d预后的预测作用与较低水平者差异有统计学意义,淋巴细胞OX40L表达较hs-CRP水平更能提示近期预后。Logistic回归分析显示:年龄(OR:2.37,95%CI 1.10～4.81,P<0.05)、血糖水平(OR:2.46,95%CI1.16～4.92,P<0.05)、淋巴细胞OX40L表达水平(OR:4.20,95%CI 2.41～7.09,P<0.05)、血清hs-CRP(3.46,95%CI 1.39～7.82,P<0.05)为随访30d内再缺血事件发生的独立预测因素。结论:ACS患者急性期淋巴细胞OX40L表达、血清sOX40L水平可预测近期再缺血事件。

To evaluate the relationship between the OX40L expression of peripheral blood lympho-cyte and serum OX40L concentration and the risk of recurrent ischaemic events in non-ST-elevation ACS （NSTEACS） patients. Method： 336 NSTEACS patients admitted were selected. The baseline materials and read-mission because of AMI and ACS during 180 day＇s follow up were collected. The OX40L expression of peripheral blood lymphocyte and serum OX40L and hs-CRP concentrations when admitted were measured. The relationship between OX40L expression of peripheral blood lymphocyte and serum OX40L and incidence of recurrent events were analysed and the relationship compared with the hs-CRP were analysed. Result： Higher OX40L expression of peripheral blood lymphocyte attributed to higher risk of recurrent evidence of 30 days （P〈0.05） and higher hs- CRP attributed to higher risk of recurrent evidence of 30 days （P〈0.05）. Kaplan-Meier survival analyzation dem onstrated that patients with greater OX40L expression had significantly higher risk than the lower ones and OX40L expression was stronger than hs-CRP in the evaluation of risk. Age （OR：2.37, 95%CI 1.10-4.81, P〈0.05）, serum glucose concentration （OR： 2.46, 95%CI 1.16-4.92, P〈0.05）, OX40L expression of peripheral blood lymphocyte （OR：4.20, 95%CI 2.41-7.09, P〈0.05） and hs-CRP conccentration （3.46, 95%CI 1.39-7.82, P〈0.05） were the independent predictive factors. Conclusion：OX40L expression of lymphocyte during acute phase in NSTEACS patients may forecast the incidence of recurrent events.