CD40L高表达在急性冠脉综合征病人中的临床意义

THE CLINICAL SIGNIFICANCE OF HIGH EXPRESSION OF CD40L IN PATIENTS WITH ACUTE CORONARY SYNDROMES

为探讨急性冠脉综合征 (ACS)病人外周血单核细胞表达CD40L及血清可溶性CD40L(sCD40L)变化的临床意义 ,应用间接免疫荧光流式细胞术和ELISA分别对正常对照组 16例、稳定型心绞痛 (SA) 2 4例 (包括8例PTCA)、不稳定型心绞痛 (UA) 2 0例、急性心肌梗死 (AMI) 12例的外周血单核细胞表达CD40L及sCD40L水平进行检测。结果显示 :(1)UA组及AMI组血单核细胞表达CD40L明显较SA和对照组高 (P <0 .0 1) ,SA与对照组相比无差异 (P >0 .0 5 ) ;(2 )UA组及AMI组血清sCD40L水平明显较SA和对照组高 (P <0 .0 1) ,而SA与对照组相比亦有明显差异 (P <0 .0 5 ) ;(3)AMI患者血清sCD40L水平与UA组比较无显著性差异 (P >0 .0 5 ) ,但AMI发病后 2 4hsCD40L有一峰值 ;(4 )PTCA后血清sCD40L明显高于PTCA前 (P <0 .0 1) ,但血单核细胞表达CD40L无显著性差异 (P >0 .0 5 ) ;(5 )血清sCD40L水平与冠脉病变的复杂狭窄数相关 (γ =0 .5 4,P <0 .0 1)。提示血清可溶性CD40L升高在ACS的发生和发展中具有重要作用 。

To investigate the clinical significance of the expression of CD40L on peripheral blood monocytes and the changes in serum soluble CD40L in patients with acute coronary syndrome, 16 normal controls and fifty-six patients including 24 with SA (8 patients after PTCA), 20 with UA and 12 with AMI entered in this study. The expression of CD40L on monocytes was analyzed by indirect immonofluorescence flow cytometry and serum sCD40L levels were measured by ELISA. The results showed: (1) The expression of CD40L on monocytes in UA and AMI were higher compared with SA and controls ( P <0.01), while no significant difference was found between SA and controls( P >0.05). (2) Patients with UA and AMI had significantly raised serum levels of sCD40L when compared with patients with SA and controls( P <0.01), and the difference was significant between patients with SA and controls . (3) In the patients with AMI, the levels of sCD40L showed no significant increase when compared to patients with UA, while AMI patients had a peak level of sCD40L at 24h after AMI. (4) PTCA induced a marked rise in sCD40L levels in all patients, while the expression of CD40L on monocytes showed no significant difference between patients with PTCA before and after operation. (5) A significant correlation was observed between sCD40L serum concentration and the number of complex lesions(γ=0.54, P <0.01). The results suggest that the elevation of serum soluble CD40L may play an important role in acute coronary syndrome and may represent a marker of coronary disease activity.