冠心病患者外周血CD45、HMGB1水平与支架内再狭窄的相关性分析

Correlation among CD45,HMGB1 and in-stent restenosis in patients with coronary heart disease

目的探讨冠状动脉粥样硬化性心脏病(冠心病)患者外周血白细胞共同抗原(CD45)两种异型CD45RA+T细胞、CD45RO+T细胞及高迁移率族蛋白B1(HMGB1)水平与冠状动脉(冠脉)支架内再狭窄的相关性。方法选取2019年3月至2020年9月于江西鄱阳湖医院住院治疗并行冠脉支架植入术的122例冠心病患者为研究对象,根据术后1年内是否发生支架内再狭窄将患者分为再狭窄组(n=30)和未狭窄组(n=92)。采用酶联免疫吸附(ELISA)法检测术后24 h患者外周血HMGB1水平,采用流式细胞术检测CD4+CD45RA+T细胞、CD4+CD45RO+T细胞水平;分析冠脉支架内再狭窄患者外周血CD4+CD45RA+T细胞、CD4+CD45RO+T细胞与HMGB1水平相关性以及对冠脉支架内再狭窄的预测价值;探讨冠脉支架内再狭窄的影响因素。结果再狭窄组外周血CD4+CD45RA+T细胞、CD4+CD45RO+T细胞、HMGB1、TC水平高于未狭窄组,HDL-C水平低于未狭窄组(P<0.05)。冠脉支架内再狭窄患者外周血CD4+CD45RA+T细胞、CD4+CD45RO+T细胞与HMGB1水平均呈正相关(r=0.490、0.563,P<0.05)。外周血CD4+CD45RA+T细胞、CD4+CD45RO+T细胞、HMGB1及三者联合预测支架内再狭窄的曲线下面积(AUC)分别为0.897、0.884、0.889、0.957,特异性分别为85.9%、81.5%、84.8%、85.9%,敏感度分别为83.3%、80.0%、86.7%、93.3%。CD4+CD45RA+T细胞、HMGB1是影响冠心病患者冠脉支架内再狭窄的独立危险因素(P<0.05)。结论冠心病患者外周血CD4+CD45RA+T细胞、CD4+CD45RO+T细胞、HMGB1高水平与发生冠脉支架内再狭窄密切相关。

Objective To investigate the correlation among levels of CD45RA+T cells and CD45RO+T cells(two types of leukocyte common antigen CD45)and level of high mobility group Box-1 protein(HMGB1)in peripheral blood and in-stent restenosis(ISR)in patients with coronary heart disease(CHD).Methods CHD patients(n=122)undergone intracoronary stent implantation were chosen from JiangXi Poyanghu Hospital from Mar.2019 to Sept.2020,and divided,according to whether or not ISR occurred after the operation for 1 y,into restenosis group(n=30)and non-restenosis group(n=92).The level of HMGB1 in peripheral blood was detected by using ELISA after the operation for 24 h.The levels of CD4+CD45RA+T cells and CD4+CD45RO+T cells were detected by using flow cytometry.The correlation among CD4+CD45RA+T cells level,CD4+CD45RO+T cells level and HMGB1 level was analyzed,and their predictive value to coronary artery ISR.The influence factors of coronary artery ISR were discussed.Results The levels of CD4+CD45RA+T cells,CD4+CD45RO+T cells,HMGB1 and total cholesterol(TC)were higher,and level of high-density lipoprotein-cholesterol(HDL-C)was lower in restenosis group than those in non-restenosis group(P<0.05).The levels of CD4+CD45RA+T cells and CD4+CD45RO+T cells were positively correlated to HMGB1 level(r=0.490,r=0.563,P<0.05).In the prediction of ISR,the AUC of CD4+CD45RA+T cells,CD4+CD45RO+T cells and HMGB1 and CD4+CD45RA+T+CD4+CD45 RO+T+HMGB1 was,respectively,0.897,0.884,0.889 and 0.957,the specificity was,respectively,85.9%,81.5%,84.8%and 85.9%,and the sensitivity was,respectively,83.3%,80.0%,86.7%and 93.3%.CD4+CD45RA+T cells and HMGB1 were independent risk factors of coronary artery ISR in CHD patients(P<0.05).Conclusion The high levels of CD4+CD45RA+T cells,CD4+CD45RO+T cells and HMGB1 in peripheral blood are closely correlated to incidence of coronary artery ISR in CHD patients.