急性冠状动脉综合征患者外周血单个核细胞表达CD40和非HDL-C的相关性研究

Correlation of CD40 and Non-HDL-C Expressed by Peripheral Blood Mononuclear Cells in Patients with Acute Coronary Syndromes

目的:探讨急性冠状动脉综合征(acute coronary syndromes,ACS)患者外周血单个核细胞表达白细胞分化抗原40(Cluster of Differentiation 40,CD40)和血清非高密度脂蛋白胆固醇(HDL-C)的相关性。方法:选取深圳市坪山区人民医院心血管内科2019年9月—2020年12月收治的52例住院患者作为研究对象。依据WHO1979年制订的标准并参考《2000年ACC/AHA(美国心脏病学会)的诊断指南》和《急性ST段抬高心肌梗死诊断和治疗指南》将其分为ACS组21例、稳定性心绞痛(stable angina,SA)组16例及以非冠状动脉粥样硬化心脏病(简称冠心病)的患者作为对照组15例。比较三组患者外周血单个核细胞表达CD40的平均荧光强度(mean fluorescent intensity,MFI)表达、血清非HDL-C水平及血清C反应蛋白(CRP)水平情况。结果:ACS组外周血单个核细胞表达CD40水平较SA组和对照组高,差异有统计学意义(t=-6.654、-5.062,P<0.05),SA组与对照组比较,差异无统计学意义(t=1.829,P>0.05)。三组患者MFI比较,差异有统计学意义(F=34.481,P<0.05)。ACS组血清CRP表达水平为(13.04±16.74)mg/L,高于SA组的(1.58±1.19)mg/L及对照组的(1.43±1.10)mg/L,差异有统计学意义(t=-2.014、-2.536,P<0.05),SA组与对照组比较,差异无统计学意义(t=0.138,P>0.05)。三组患者血清CRP水平比较,差异有统计学意义(F=4.123,P<0.05)。ACS组血非HDL-C水平为(3.78±1.31)mmol/L,高于SA组的(3.31±1.06)mmol/L及对照组的(2.50±0.70)mmol/L,差异有统计学意义(t=-2.661、-2.677,P<0.05),SA组与对照组比较,差异无统计学意义(t=-1.804,P>0.05)。三组患者非HDL-C水平相比,差异有统计学意义(F=4.567,P<0.05)。CD40与CRP呈显著相关性(r=0.407,P<0.05),CD40与非HDL-C呈显著相关性(r=0.379,P<0.05)。结论:动脉粥样硬化斑块中的多种细胞因子相互作用,影响斑块的稳定性,而血清中细胞因子水平直接或间接地反映了斑块炎症程度和稳定性状况。因此,外周血单个核细胞表达CD40可能是冠脉病变活动性临床标志物,有望成为预测ACS发生及识别易损斑块的敏感指标,为预防和治疗ACS提供新的思路。

Objective:To investigate the correlation between peripheral blood mononuclear cells expressing leukocyte Cluster of Differentiation antigen 40(CD40)and serum non-high-density lipoprotein cholesterol(HDL-C)in patients with acute coronary syndromes(ACS).Methods:52 hospitalized patients admitted to the hospital from September 2019 to December 2020 were selected for the study.According to the criteria established by WHO in 1979 and with reference to the 2000 ACC/AHA(American College of Cardiology)Diagnostic Guidelines and Guidelines for the Diagnosis and Treatment of Acute ST-Segment Elevation Myocardial Infarction,21 cases were divided into the ACS group,16 cases were divided into the stable angina group,and 15 cases were divided into the control group of patients with non-coronary atherosclerotic heart disease(coronary heart disease for short).Mean fluores-cent intensity(MFI)expression of CD40-expressing peripheral blood single nucleated cells,serum non-HDL-C levels,and serum CRP levels were compared among the three groups of patients.Results:The peripheral blood single nucleated cells in the ACS group expressed significantly higher levels of CD40 than those in the SA group and the control group,and the difference was statis-tically significant(t=-6.654,-5.062,P<0.05),and there was no statistically significant difference when comparing the SA group with the control group(t=1.829,P>0.05).The difference in MFI among the 3 groups was statistically significant(F=34.481,P<0.05).The serum CRP expression level in the ACS group was(13.04±16.74)mg/L,which was higher than(1.58±1.19)mg/L in the SA group and(1.43±1.10)mg/L in the control group,and the difference was statistically significant(t=-2.014,-2.536,P<0.05),and there was no statistically significant difference between the SA group and the control group(t=0.138,P>0.05).The difference in serum CRP levels among the 3 groups was statistically significant(F=4.123,P<0.05).The blood non-HDL-C level in the ACS group was(3.78±1.31)mmol/L,which was higher than that of(3.31±1.06)mmol/L in the SA group and(2.50±0.70)mmol/L in the control group,and the difference was statistically significant(t=-2.661,-2.677,P<0.05),and the difference between the SA group and the control group was not statistically significant(t=-1.804,P>0.05).The difference was statistically significant compared with non-HDL-C in the 3 groups(F=4.567,P<0.05).CD40 showed significant correlation with CRP(r=0.407,P<0.05),and CD40 showed a significant correlation with non-HDL-C(r=0.379,P<0.05).Conclusion:Multiple cytokine interactions in athero-sclerotic plaques affect plaque stability,and serum cytokine levels directly or indirectly reflect the degree of plaque inflammation and stability status.Therefore,the expression of CD40 by peripheral blood single nucleated cells may be a clinical marker of coro-nary lesion activity,which is expected to be a sensitive indicator for predicting the occurrence of ACS and identifying vulnerable plaques,and provides new ideas for the prevention and treatment of ACS.