稳定性冠心病患者外周血单核细胞亚型分布特征及影响因素

Distribution Characteristics of Peripheral Blood Monocyte Subsets in Patients with Stable Coronary Artery Disease and Influencing Factors

目的通过三色流式细胞术分析稳定性冠心病(stable coronary artery disease,SCAD)患者外周血单核细胞亚型分布特征,并分析影响其亚型分布的因素。方法观察纳入162例住院行冠状动脉造影(coronary angiography,CAG)患者,根据临床表现、实验室检查、心电图及CAG诊断SCAD患者(SCAD组)96例,非冠心病患者(对照组)66例。均于清晨空腹抽取患者外周静脉血,行三色流式细胞术分析单核细胞亚型,分为经典型单核细胞(classical monocytes,CMs;CD14++CD16-)、中间型单核细胞(intermediatemonocytes,IMs;CD14++CD16+)、非经典型单核细胞(nonclassical monocytes,NCMs;CD14+CD16++),记录患者一般临床资料并进行统计学分析。结果 IMs比例SCAD组(9.42±3.32)显著高于对照组(7.62±2.01)(P <0.01),CMs和NCMs两型比例两组间差异无统计学意义;多因素Logistic回归分析提示,IMs与SCAD独立相关(OR=0.396,95%CI:0.186～0.857,P <0.05);相关性分析提示,IMs与高敏C反应蛋白(high-sen-sitivity C-reactive protein,hs-CRP)呈正相关(r=0.859,P <0.01)。受试者工作特征(ROC)曲线显示,IMs预测SCAD的最佳界值为8.68%,敏感度0.625,特异度0.955。结论外周血IMs比例与SCAD密切相关,可望成为稳定性冠心病的预测指标,这可能与hs-CRP等炎症因子水平有关。

Objective The distribution characteristics of peripheral blood monocyte subsets in patients with stable coronary artery disease(SCAD)by three-color flow cytometry and the factors affecting the distribution of intermediate monocyte subset were analyzed.Methods 162 patients were enrolled.96 patients with SCAD(SCAD group)and 66 patients with non-coronary artery disease(control group)were diagnosed according to clinical mani-festations,laboratory tests,electrocardiogram and coronary angiography(CAG).Peripheral venous blood was taken from the patients in the morning on an empty stomach.The monocyte subsets were analyzed by a three-color flow cy-tometry and divided into classical monocytes(CMs;CD14++CD16-)and intermediate monocyte subsets(IMs;CD14++CD16+),nonclassical monocytes(NCMs;CD14+CD16++).The clinical characteristics of the patients were recorded and analyzed statistically.Results The IMs ratio of SCAD group(9.42±3.32)was significantly higher than the control group(7.62±2.01)(P<0.05),whereas there was no significant difference between these two groups in CMs and NCMs.Multivariate logistic regression analysis suggested that IMs ratio was independently corre-lated with SCAD(OR=0.396,95%CI:0.186~0.857,P<0.05).Correlation analysis suggested that IMs was posi-tively correlated with high-sensitivity C-reactive protein(hs-CRP)(r=0.859,P<0.01).The receiver operating characteristic(ROC)curve showed that IMs ratio predicted SCAD with a best cutoff value of 8.68%,sensitivity of 0.625,and specificity of 0.955.Conclusion Peripheral blood IMs ratio is closely related to SCAD and expected to be a predictor of SCAD,which may be related to the level of inflammatory factors such as hs-CRP.