急性冠状动脉综合征患者外周血单个核细胞TLR4和TNF-α的变化及其临床意义

Changes of Toll-like receptor 4 and tumor necrosis factor-α in patients with acute coronary syndrome and its clinical significance

目的观察急性冠状动脉综合征(ACS)患者外周血单个核细胞Toll样受体4(TLR4)和血清肿瘤坏死因子α(TNF-α)浓度的变化及其与冠状动脉病变严重程度的相关性,并探讨其临床意义。方法根据临床表现、心电图及冠状动脉造影结果等综合诊断选择ACS患者60例、稳定型心绞痛(SAP)患者20例、对照者20例为研究对象。其中ACS患者包括急性心肌梗死(AMI)30例和不稳定型心绞痛(UAP)30例,其冠状动脉病变程度根据Gensini积分进行评估;对照者为同期行冠状动脉造影检查排除冠心病者。采用流式细胞术检测各组外周血TLR4表达水平,同时采用ELISA检测血清TNF-α浓度。结果 ACS患者外周血TLR4表达水平和血清TNF-α浓度显著高于对照组和SAP组(P<0.01),而TLR4表达水平在AMI组与UAP组之间、SAP组与对照组之间无显著差异(P>0.05)。ACS患者经PCI治疗后外周血TLR4表达水平和血清TNF-α浓度较术前明显下降(P<0.05);ACS患者外周血TLR4表达水平和血清TNF-α浓度与冠状动脉病变Gensini积分呈正相关(r=0.715,P<0.01;r=0.333,P<0.01)。结论 ACS患者外周血TLR4表达水平显著升高,炎症因子TNF-α的分泌增加,提示二者共同参与ACS的进展过程,并存在一定的相关性;外周血TLR4和TNF-α与冠状动脉病变程度密切相关,经PCI治疗后二者的表达明显降低,提示心肌灌注治疗可能改善冠状动脉的炎症反应。

Aim To observe the changes of Toll-like receptor 4 （TLR4） and tumor necrosis factor-α（TNF-α） in patients with acute coronary syndrome （ACS） and its correlation with the severity of coronary artery disease, and to explore its clinical significance. Methods 60 patients with ACS, 20 patients with stable angina pectoris （SAP） and 20 patients with normal control group were selected according to clinical manifestation, ECG and the results of coronary angiography. The ACS patients included 30 patients with acute myocardial infarction （AMI） and 30 patients with unstable angina pectoris （UAP）. The degree of coronary artery lesion was evaluated according to the improved Gensini score. In the control group, coronary artery angiography was performed to exclude coronary artery disease. The levels of TLR4 in peripheral blood of 100 patients were detected by flow cytometry, and the concentration of TNF-α in serum were detected by ELISA. Results The levels of TLR4 and TNF-α in ACS group were significantly higher than those in control group and SAP group （P〈0.01）, while TLR4 levels were not significantly different between AMI group and UAP group, SAP group and control group （P〉0.05）. The levels of TLR4 and TNF-α in patients with ACS decreased but there were significantly lower than those in SAP group and control group （P〈0.05）. There was a positive correlation between the expression of TLR4 and TNF-α in blood and the Gensini score of coronary artery lesion （r=0.715, P〈0.01; r=0.333, P〈0.01）. Conclusions The level of TLR4 in peripheral blood of patients with ACS significantly increased, and the secretion of TNF-α increased. It was suggested that TLR4 and TNF-α concentrations in peripheral blood of patients with ACS were related to the progression of ACS. The levels of TLR4 and TNF-α in peripheral blood were closely related to the degree of coronary artery disease, and after PCI treatment, the expression of TLR4 and TNF-α decreased significantly. It is suggested that myocardial perfusion therapy may improve the coronary artery inflammation.