外周血单核细胞亚群及其趋化因子在急性冠脉综合征早期的表达特点

Characteristic of peripheral blood monocyte subsets and chemokines in early stage of acute coronary syndrome

目的探讨急性冠脉综合征(acute coronary syndrome,ACS)早期单核细胞亚群及其趋化因子即单核细胞趋化蛋白-1(monocyte chemoattractant protein,MCP-1)和不规则趋化因子(fractalkine,FKN)的表达特点,并分析其相关性。方法选取我院2016年9月至12月以胸痛症状入院拟行冠脉造影术(coronary angiography,CAG)的患者。手术当天术前抽取静脉血,采用流式细胞术检测外周血单核细胞(monocyte,Mon)3个亚型的含量及其比例,依据分化抗原-14(cluster differentiation-14,CD-14)和CD16表达分为3个亚型即CD14+CD16-Mon(Mon1)、CD14+CD16+Mon(Mon2)和CD14-CD16+Mon(Mon3);手术当天术前及术后一天抽取静脉血,ELISA检测Mon1的趋化因子MCP-1和Mon3的趋化因子FKN水平,比较不同组MCP-1-Mon1和FKN-Mon3水平变化,并分析其相关性。结果共入选70例患者,结合其临床症状、心肌标志物、心电图、CAG检查结果进行诊断分组:急性心肌梗死(acute myocardium infarction,AMI)组患者30例、不稳定性心绞痛(unstable angina pectoris,UAP)组患者25例、CAG完全正常者(对照组)15例。流式细胞术结果显示AMI组Mon1所占比例高于UAP组和正常对照组(P<0.05),Mon3在各组间尚无差异。AMI组患者外周血Mon3/Mon1比值低于对照组(P<0.05)。AMI组和UAP组患者FKN、MCP-1和红细胞分布宽度均高于对照组,并且FKN和Mon3具有强相关性(P<0.05;R=0.650 2)。结论单核细胞亚群(Mon1和Mon3)在ACS早期水平增高,并伴有其负责招募的趋化因子(MCP-1和FKN)增加,且FKN和Mon3具有强相关性,提示MCP-1-Mon1和FKN-Mon3两条通路可能参与患者ACS早期病理生理过程。

Objective To investigate the expression of monocyte subsets and their chemokine, i.e., monocyte chemoattractant protein （MCP-1） and fractalkine （FKN）, in patients with acute coronary syndrome （ACS）, and to analyze their correlation. Methods Patients with the syndrome of pectoralgia and to be inspected with coronary angiography （CAG） in our hospital from Sep. to Dec., 2016 were included. Patients’ venous blood was collected on the operation day before operation, the level and proportion of monocyte （Mon） subsets, which was namely CD14＋CD16-Mon （Mon1）, CD14＋CD16＋Mon （Mon2） and CD14-CD16＋Mon （Mon3） according to the expression of cluster differentiation-14 （CD14） and CD16, were detected by flow cytometry （FCM）. Patients’ venous blood was collected on the operation day before operation and one day after operation, the concentrations of MCP-1 and FKN in plasma were measured by ELISA. We compared the expression levels of MCP-1-Mon1 and FKN-Mon3, and analyzed their relationship between each other respectively in different groups. Results Diagnosed according to the clinical symptoms, myocardial markers, electrocardiogram and CAG results, 70 individuals were analyzed, including 30 patients with acute myocardial infarction （AMI group）, 25 patients with unstable angina pectoris （UAP group） and 15 patients with the chest pain symptoms and normal CAG results （control group）. The percentage of Mon1 in the AMI group was higher than that in the other groups （P〈0.05）; no difference was observed for Mon3 among the groups （P〉0.05）. The Mon3/Mon1 ratio in the AMI group was lower than that in the control group （P〈0.05）. Moreover, the levels of FKN and MCP-1 in the ACS group were greater than those in the control group. The level of red blood cell distribution width （RDW） was significantly increased in the AMI and UAP group than that in the control group （P〈0.05）. There was a significant correlation between FKN and Mon3 （P〈0.05, R=0.650 2）. Conclusions The monocyte subset of Mon1 and Mon3 increased in the early stage of ACS, with their chemokine （FKN and MCP-1） increasing at the same time. There is a significant correlation between FKN and Mon3, which indicates MCP-1-Mon1 and FKN-Mon3 may participate in the pathophysiological process of early ACS in patients.