冠状动脉粥样硬化性心脏病患者外周血共刺激分子CTLA-4、CD28的表达

Expression of cytotoxic T lymphocyte associated antigen-4 and cluster of differentiation 28 in peripheral blood of patients with coronary heart disease

目的探讨冠状动脉(冠脉)粥样硬化性心脏病(coronary heart disease,CHD)患者外周血细胞毒性T淋巴细胞相关抗原-4(cytotoxic T lymphocyte associated antigen-4,CTLA-4)、分化抗原簇28(cluster of differentiation 28,CD28)及淀粉样蛋白A(serum amyloid A protein,SAA)的表达。方法选择2017年7月至2018年6月南京医科大学康达学院第一附属医院CHD患者43例为研究对象,其中稳定型心绞痛患者21例,急性冠脉综合征患者22例。另外,选择同期20例经冠脉造影证实的非CHD患者为正常对照组。患者在起病入科时抽取外周血,CTLA-4、CD28及SAA的浓度采用酶联免疫吸附法(enzyme-linked immunoassay,ELISA)检测。结果与正常对照组比较,稳定型心绞痛组、急性冠脉综合征组患者外周血CTLA-4浓度降低,SAA、CD28浓度升高且急性冠脉综合征组浓度升高更高,差异有统计学意义(P<0.05);急性冠脉综合征组SAA与CD28呈正相关(r=0.871,P<0.01),与CTLA-4呈负相关(r=-0.642,P<0.01)。结论 CHD患者外周血CTLA-4浓度降低,CD28浓度升高,急性冠脉综合征患者更甚,且其与常规的SAA检测指标呈相关性,可用于评估病情的严重程度并作为CHD治疗的新靶点。

Objectives To investigate peripheral blood concentrations of cytotoxic T lymphocyte associated antigen-4(CTLA-4),cluster of differentiation 28(CD28)and serum concentration of amyloid A protein(SSA)in patients with coronary heart disease(CHD). Methods From July 2017 to June 2018 in The Hospital of Lianyungang Affiliated to Xuzhou Medical University 2017,43 patients with CHD were enrolled,including 21 patients with stable angina pectoris and 22 patients with acute coronary syndrome. At the same period,20 patients with non-CHD confirmed by coronary angiography were in normal control group. Peripheral blood were drawn when the patients were admitted to the department,and CTLA-4,CD28,SAA were detected by enzyme-linked immunoassay(ELISA). Results Compared with normal control group,while concentration of CTLA-4 in peripheral blood of stable angina group and acute coronary syndrome group decreased,while concentrations of SAA and CD28 increased. Concentrations of SAA and CD28 increased more obviously in acute coronary syndrome group. The differences of concentrations of SAA and CD28 between the two groups were statistically significant(P<0.05). In acute coronary syndrome group,SAA positively correlated with CD28(r=-0.874,P<0.01),and negatively correlated with CTLA-4(r=-0.642,P<0.01). Conclusions Concentrations of CTLA-4 in peripheral blood of patients with CHD decreases,concentration of CD28 increases,and they do more obviously in patients with acute coronary syndrome. They correlate with concentration of SAA(the routine test index),and can be used to assess the severity of the disease and as a new treatment target for CHD.