急性冠脉综合征患者血清巨噬细胞集落刺激因子和白介素-10水平变化的临床意义

目的观察血清巨噬细胞集落刺激因子 (M-CSF)、白介素-10 (IL-10) 水平在急性冠脉综合征(ACS)患者中的变化,探讨其与斑块稳定性的关系.方法 ACS患者38 例(ACS组):急性心肌梗死(AMI)组20例,不稳定型心绞痛(UAP) 组18 例;稳定型心绞痛(SAP) 组17 例;对照组17 例.用ELISA法测定血清巨噬细胞集落刺激因子及白介素-10水平.结果血清M-CSF水平AMI组高于SAP组和对照组(P均<0.05),UAP组高与SAP组和对照组(P均<0.05),AMI组与UAP 组比较差异无显著性(P>0.05);血清IL-10水平AMI组高于UAP组、SAP组和对照组(P均<0.05), UA组高于SAP组和对照组(P均<0.05);ACS病人血清IL-10和M-CSF水平呈正相关关系(r=0.352,P<0.05).结论 (1)ACS患者血清M-CSF升高反映斑块的不稳定性.(2)急性冠脉综合征患者血清IL-10升高,并且与血清M-CSF水平呈正相关关系反映了在动脉粥样硬化斑块中作为抗炎因子的IL-10与其他炎症因子相互作用的复杂性.     

Toll样受体4和单核细胞趋化蛋白1与急性冠状动脉综合征的相关性研究

目的探讨急性冠状动脉综合征(ACS)患者外周血单核细胞Toll样受体4(TLR4)和单核细胞趋化蛋白1(MCP-1)的表达及临床意义。方法入选对象包括ACS组患者50例:经临床及冠状动脉造影检查明确诊断[其中急性心肌梗死(AMI)25例,不稳定型心绞痛(UA)25例];稳定型心绞痛(SA)组患者13例;对照组患者30例:同期住院冠状动脉造影阴性且排除了冠心病诊断。采用流式细胞术检测外周血单核细胞上TLR4的表达,用酶联免疫吸附法检测血清中MCP-1的表达。结果 AMI、UA、SA组和对照组外周血单核细胞上TLR4的表达分别为76.56%±6.32%、73.70%±7.67%、63.20%±6.86%和54.20%±9.34%,ACS组显著高于SA组(P<0.05)和对照组(P<0.01),而SA组又高于对照组(P<0.05);AMI、UA、SA组和对照组血清中MCP-1的表达分别为(161.52±40.30)ng/L、(156.63±34.10)ng/L、(141.32±29.26)ng/L和(125.20±20.75)ng/L,ACS组显著高于SA组(P<0.05)和对照组(P<0.01),而SA组又高于对照组(P<0.05)。ACS组外周血单核细胞上TLR4表达与血清MCP-1水平呈正相关(r=0.876,P<0.01)。结论 TLR4介导的免疫炎症机制参与了冠心病的发生、发展,推测TLR4和MCP-1可能与动脉粥样硬化相关。     

急性冠状动脉综合征患者循环血单核细胞Toll样受体4的表达及其意义

目的:探讨急性冠状动脉综合征(ACS)患者循环血单核细胞Toll样受体4(TLR4)、肿瘤坏死因子-α(TNF-α)和超敏C反应蛋白(hsCRP)的表达及其临床意义.方法:92例入选者分为4组:ACS组,48例(其中急性心肌梗死24例,不稳定型心绞痛24例);稳定型心绞痛组,12例;正常对照组,32例.比较各组间TLR4 、TNF-α、hsCRP表达差异, 分析TLR4与TNF-α、hsCRP的相关性.结果:ACS组TLR4、TNF-α、hsCRP的表达均较稳定型心绞痛组和正常对照组显著增高(P<0.05),TLR4与TNF-α、hsCRP呈正相关(P<0.05).结论:ACS患者TLR4的表达增高,提示TLR4启动的免疫炎症机制参与冠心病的发生、发展.     

急性冠状动脉综合征与尿酸、脂蛋白a的关系

目的探讨联合检测尿酸、脂蛋白a与急性冠状动脉综合征（ACS）的关系。方法检测急性心肌梗死患者（AMI，30例）、不稳定型心绞痛患者（UAP，30例）、稳定型心绞痛患者（SAP，30例）和对照组患者（30例）的血尿酸、脂蛋白a，同时对上述患者进行冠脉造影。结果冠心病组血尿酸、脂蛋白a明显高于对照组（P〈0．01），冠心病各组问尿酸水平差异无统计学意义（P〉0．01），脂蛋白a差异有统计学意义（P〈0．01）。AMI和UAP组脂蛋白（a）与对照组和SAP组比较差异有统计学意义（P〈0．01）。尿酸和脂蛋白a无相关性（P〉0．01）。结论血尿酸、脂蛋白a是冠心病重要的发病因素，脂蛋白a可预测ACS的发生。     

急性冠状动脉综合征患者载脂蛋白A5检测及其意义

目的 探讨血清载脂蛋白A5(APOA5)水平与急性冠状动脉综合征(ACS)患者血脂谱及高敏性C反应蛋白(hs-CRP)的关系.方法 入选587例受试对象,分为对照组(n=232)、稳定性心绞痛(SA)组(n=127)、不稳定性心绞痛(UA)组(n=116)和急性心肌梗死(AMI)组(n=112).抽血分离血清,分别采用ELISA法和免疫比浊法测定血清APOA5以及hs-CRP,并测定血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C).比较各组ApoA5、hs-CRP和血脂的血清浓度差异,分析三者之间的相互关系.结果 UA组[(340.6±63.5)μg/L]和AMI组[(373.2±73.8)μg/L]的ApoA5浓度明显高于对照组[(108.7±23.2)μg/L]和SA组[(78.3±20.2)μg/L](均P<0.05).UA组和AMI组的ApoA5与TG(r=0.63和0.67,P<0.05)和hs-CRP(r=0.57和0.55,P<0.05)呈正相关,而ApoA5与TC、HDL-c和LDL-C无明显相关(P>0.05).结论 ACS患者中血清ApoA5浓度显著升高,与血清TG或hs-CRP浓度显著正相关,提示ApoA5的代谢和生理功能在ACS期间均发生了变化,这可能与炎症反应增强有关.     

急性冠状动脉综合征患者血清单核细胞趋化蛋白-1和干细胞因子的变化

目的:检测急性冠状动脉综合征(ACS)患者血清单核细胞趋化蛋白-1(MCP-1)和干细胞因子(SCF)的变化,探讨MCP-1和SCF与ACS的关系.方法:纳入急性心肌梗死患者41例,不稳定型心绞痛患者45例,对照组32例,应用ELISA法测定其血清MCP-1和SCF的水平.结果:心肌梗死组和心绞痛组MCP-1水平均明显高于对照组(P<0.01和P<0.05).心肌梗死组及心绞痛组SCF水平略高于对照组,但差异无统计学意义.心肌梗死组MCP-1及SCF水平与血白细胞数、中性粒细胞比率及血脂等水平均无明显相关性.结论:ACS患者尤其是急性心肌梗死患者血MCP-1明显升高,SCF亦有所增加.MCP-1和SCF可能与ACS的发生发展及梗死后的心肌修复有关.     

Changes in serum interleukin-6 and high-sensitivity C-reactive protein levels in patients with acute coronary syndrome and their responses to simvastatin

The role of inflammation in acute coronary syndrome (ACS) and the mechanism by which statin treats ACS is explored. Serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels were measured in 50 patients with ACS [including 30 cases with unstable angina (UA) and 20 patients with acute myocardial infarction (AMI)], 34 patients with stable angina (SA), and 30 controls. Patients in the ACS group were randomly assigned to a simvastatin group (including a simvastatin AMI subgroup, n = 11 and a simvastatin UA subgroup, n = 14) and a routine group (including a routine AMI subgroup, n = 9 and a routine UA subgroup, n = 16). The simvastatin group was given simvastatin 20mg/day and the routine group a placebo. After a 3-week follow-up, serum hs-CRP, IL-6 levels, and serum lipid concentrations were measured again. Both serum IL-6 and hs-CRP levels were significantly higher in the ACS group (including the UA and AMI subgroups) than in the SA and control groups (P < 0.001). After 3 weeks of treatment with simvastatin, the serum IL-6, hs-CRP, total cholesterol, and low-density lipoprotein cholesterol levels were decreased significantly in the simvastatin group (P < 0.001), but no significant changes were observed in the routine group. No relationship was observed between the rate of decrease of serum IL-6 or hs-CRP and serum lipids levels. The hs-CRP level showed a significant correlation with IL-6 by Spearmans rank correlation analysis (P < 0.01). Inflammation plays an important role in the initiation of ACS. Simvastatin possesses an anti-inflammatory effect, independent of its lipid-lowering action, which may play an important role in the early treatment of ACS.     

急性冠状动脉综合征患者牛磺酸跨红细胞膜转运的变化

目的 :研究急性冠状动脉综合征 (ACS)患者牛磺酸跨红细胞膜转运的变化及临床意义。　　方法 :2 1例ACS患者 (ACS组 ) ,其中包括 1 2例急性心肌梗死 (AMI) ,9例不稳定性心绞痛 (UA) ;1 4例健康对照者(对照组 ) ,取静脉抗凝血 ,分离纯化红细胞 ,分别测定血浆、红细胞牛磺酸浓度 ,并测定3 H标记的牛磺酸跨红细胞膜转运。　　结果 :ACS组血浆牛磺酸含量与对照组比无明显差异 (P >0 0 5) ,而红细胞内牛磺酸含量较对照组降低了 36 % (P<0 0 1 )。ACS组牛磺酸跨红细胞膜转运能力下降 ,其最大速率 (Vmax)降低了 30 % (P <0 0 1 ) ,转运米氏常数 (Km)增加了 75% (P <0 0 1 ) ;红细胞牛磺酸含量、牛磺酸转运Vmax、Km在UA者与AMI者间均无显著差异 ,且与AMI患者CK峰值无明显相关。　　结论 :ACS患者存在牛磺酸跨红细胞膜转运障碍。     

辅助性T细胞17、辅助性T细胞17/辅助性T细胞1比例在急性冠状动脉综合征的变化及临床意义

目的探讨急性冠状动脉综合征(ACS)患者外周血辅助性T细胞(Th)17、Th17/Th1比例及血浆中白细胞介素17(IL-17)和IL-22的变化及意义。方法选择冠心病患者50例,其中急性心肌梗死(AMI)组20例,不稳定型心绞痛(UA)组15例,稳定型心绞痛(SA)组15例;健康查体者15例作为正常对照组。采用流式细胞分析法,检测各组外周血Th17、Th17/Th1细胞占CD4+T细胞比例。采用酶联免疫吸附法检测患者血浆IL-17和IL-22的浓度。结果AMI组和UA组外周血Th17细胞比例[(2.98%±1.01%)和(2.63%±0.61%)]、Th17/Th1细胞比例[(0.71%±0.35%)和(0.66%±0.31%)]均明显高于SA组及正常对照组(均P<0.05)。AMI组血浆IL-17(24.41±7.95 ng/L)和IL-22(34.18±7.04 ng/L)浓度均显著高于SA组和正常对照组(均P<0.05);UA组血浆IL-17浓度(22.86±8.62ng/L)显著高于正常对照组,血浆IL-22浓度(28.98±4.35 ng/L)显著低于AMI组而高于正常对照组。ACS组IL-22浓度与IL-17浓度呈显著正相关(r=0.422,P<0.01),且ACS组Th17细胞与IL-17(r=0.722,P<0.01)、IL-22(r=0.400,P<0.01)浓度均呈显著正相关。结论 Th17细胞可能参与动脉粥样斑块不稳定和ACS的发病。Th17细胞及其相关炎性因子IL-17、IL-22可作为诊断急性心血管事件发生的辅助检测指标。     

蛋白芯片法联检急性冠状动脉综合征患者血中细胞因子的意义

目的 探讨急性冠状动脉综合征(ACS)患者血中炎性细胞因子、炎性细胞相关因子及心肌损伤因子浓度的变化及临床意义.方法 运用蛋白芯片技术同步联检经冠状动脉造影及临床表现证实为ACS患者104例及对照者50例血清或血浆中10种细胞因子水平;同时对不稳定性心绞痛(UA)患者按Braunwald分级进行分析.结果 急性心肌梗死(AMI)组和UA组血清中C反应蛋白(CRP)、白介素(IL)-6、可溶性CD40L(sCD40L)、基质金属蛋白酶(MMP)-9、心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白Ⅰ(cTnⅠ)及血浆中的IL-8、内皮素(ET)-1、可溶性血管细胞黏附分子(sVCAM)-1、氨基酸N末端脑钠肽原(NT-proBNP)浓度高于对照组,差异有统计学意义(P＜0.01);AMI组cTnⅠ[(11.08±10.49) μg/L]和H-FABP[(19.80±4.60)μg/L]浓度高于UA组[cTnⅠ:(0.69±0.18)μg/L,H-FABP:(4.12±2.45)μg/L,P＜0.01],而CRP、IL-6、MMP-9、sCD40L及ET-1浓度,两组比较差异无统计学意义;UA组MMP-9、sCD40L及H-FABP的浓度与Braunwald分级存在显著正相关(分别r=0.653,r=0.745,r=0.933,均P＜0.01).随着心绞痛严重程度的增加,MMP-9、sCD40L及H-FABP水平明显升高,心绞痛Ⅰ级＜心绞痛Ⅱ级＜心绞痛Ⅲ级(P＜0.01).结论 ACS患者血中存在多种细胞因子浓度异常,其中MMP-9、sCD40L、H-FASP的浓度与UA患者心绞痛严重程度存在良好的相关性.提示上述细胞因子参与和促使了ACS的发生、发展,为ACS的危险分层、预后判断提供了可能的分子标志物依据.     

氧化型低密度脂蛋白对急性冠状动脉综合征患者血小板聚集率的影响

目的检测急性冠状动脉综合征(ACS)患者血浆氧化型低密度脂蛋白(ox-LDL)和血小板聚集率的变化并探讨ox-LDL对ACS患者血小板聚集率的影响。方法收集经冠状动脉造影确诊的48例稳定型心绞痛(SA)患者,59例不稳定型心绞痛(UA)患者以及51例急性心肌梗死(AMI)患者外周血标本,同时收集同期住院且冠状动脉造影正常的60例患者外周血标本作为对照组,通过ELISA检测血浆ox-LDL的表达水平,通过血小板聚集仪检测血小板聚集率的变化,通过体外实验加入ox-LDL检测ox-LDL对ACS患者血小板聚集率的影响。结果与对照组相比,UA组和AMI组血浆ox-LDL和血小板聚集率显著升高(P0.05),而SA组与对照组及UA组与AMI组相比血浆ox-LDL和血小板聚集率并无显著性变化(P0.05),同时ACS患者(UA和AMI)血浆ox-LDL水平与血小板聚集率呈明显正相关(r=0.651,P0.01),体外实验进一步证实ox-LDL可明显提高生理激动剂二磷酸腺苷(ADP)诱导的ACS患者血小板聚集率(P0.01)。结论 ACS患者血浆ox-LDL水平升高与血小板高聚集状态密切相关,高水平的ox-LDL可能是ACS患者血栓形成的重要危险因素,因此检测ox-LDL水平对ACS患者预后判断有重要价值。     

妊娠相关蛋白A与急性冠状动脉综合征关系

目的　探讨血清妊娠相关蛋白 A对急性冠状动脉综合征的预测和诊断。方法　采用酶联免疫测定急性心肌梗死病人 (AMI,n=2 1) ,不稳定型心绞痛病人 (U AP,n=2 1) ,稳定型心绞痛病人 (SAP,n=2 1) ,非冠心病病人 (n=2 1)的血清妊娠相关蛋白 A,同时 ,测血脂总胆固醇 (TC) ,甘油三酯 (TG) ,低密度脂蛋白胆固醇 (L DL- C) ,高密度脂蛋白胆固醇 (HDL - C) ;心肌酶乳酸脱氢酶 (L DH) ,磷酸肌酸激酶 (CK) ,磷酸肌酸激酶同工酶 (CK- MB) ,且对上述病人进行冠状动脉造影。结果　和冠状动脉造影对比 ,妊娠相关蛋白 A诊断急性冠状动脉综合征 (ACS)的灵敏度80 .0 % ,特异性为 88.1%。 Youden指数为 6 8.1%。妊娠相关蛋白 A参考值 <10 MIU / L ,妊娠相关蛋白 A在心肌梗死病人或 U AP病人比 SAP病人或非冠心病病人显著升高 (P<0 .0 5 )。且与年龄、冠状动脉病变血管数、TC、TG、L DL- C、HDL- C、L DH、CK、CK- MB指标无显著相关性 (P>0 .0 5 )。结论　妊娠相关蛋白 A可作为 ACS新的标记物指标 ,其在 ACS进行诊断和预测的作用尚待进一步研究。     

Anti-inflammatory cytokine profile in acute coronary syndromes: behavior of interleukin-10 in association with serum metalloproteinases and proinflammatory cytokines

BACKGROUND: The anti-inflammatory cytokine interleukin-10 (IL-10) downregulates the production of metalloproteinases (MMPs) and upregulates the production of their tissue inhibitors (TIMPs). The aim of this study was to assess the levels of IL-10 in patients with acute myocardial infarction (AMI) and unstable angina (UA), as well as to investigate the relationship of circulating IL-10 with the levels of MMPs (MMP-1, -2, -9), their tissue inhibitor (TIMP-1), pro-inflammatory cytokines (IL-6, tumor necrosis factor (TNF)-alpha) and serum lipids in the same patient population. METHODS: Serum MMP-1, -2, -9, TIMP-1, IL-6, TNF-alpha and IL-10 were measured by ELISA assays in 23 patients with AMI and 20 patients with UA after their hospital admission, as well as in 16 healthy controls subjects. The lipid profile was assessed by measuring the serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides. RESULTS: AMI patients exhibited significantly higher serum levels of IL-10 as compared with those of UA patients and healthy controls (both P=0.005). In contrast, there was no significant difference in IL-10 levels between UA patients and healthy controls. In AMI patients there was a statistically significant positive correlation of serum IL-10 with the levels of MMP-9 (rho=0.588, P=0.003), IL-6 (rho=0.502, P=0.015) and HDL-cholesterol (rho=0.697, P<0.001), as well as a significant negative correlation with the levels of triglycerides (rho=-0.417, P=0.048). CONCLUSIONS: Our results suggest that UA is associated with low serum activity of IL-10, while a significant elevation of this anti-inflammatory cytokine accompanies the peripheral immune responses of AMI. This observation indicates that different patterns of inflammatory reactions are implicated in the pathophysiology of two clinical conditions.     

急性冠脉综合征患者胆固醇、总胆汁酸及总胆红素检测的临床意义

目的探讨急性冠脉综合征（ACS）患者血清总胆固醇（TC）、总胆汁酸（TBA）及总胆红素（TBIL）的变化及临床意义。方法选取住院治疗的100例ACS患者为观察组,其中稳定型心绞痛（SA）39例,不稳定型心绞痛（UA）38例,急性心肌梗死（AMI）23例。同期健康体检者100例为对照组,检测两组血清总胆固醇（TC）、总胆汁酸（TBA）及总胆红素（TBIL）的水平,并做相关统计学分析。结果观察组的TC及TBA水平高于对照组,差异有统计学意义（P〈0.05）;且观察组的TC及TBA水平由SA、UA到AMI依次升高,差异有统计学意义（P〈0.05）;观察组的TBIL水平低于对照组,差异有统计学意义（P〈0.05）;观察组的TBIL水平由SA、UA到AMI依次减低,差异有统计学意义（P〈0.05）。结论 TC、TBA及TBIL联合检测对ACS的诊断及病情发展评价有重要的临床意义。     

不同类型冠心病病人血浆血栓前体蛋白和纤维蛋白原含量的变化

目的探讨血栓前体蛋白(TPP)、纤维蛋白原(Fg)水平,以评估不同类型冠心病病人高凝、血栓形成的临床意义.方法采用定量酶联免疫吸附法和全自动血凝分析仪检测冠心病病人112例,其中急性心肌梗死(AMI)46例,不稳定型心绞痛(UA)31例,稳定型心绞痛(SA)35例,另设20名正常体检者为对照组.结果TPP和Fg的阳性发生率及含量,UA组和AMI组明显高于SA组及对照组(P＜0.01);SA组病人的Fg与对照组比较无统计学意义(P＞0.05);SA组病人的TPP与对照组比较有统计学意义(P＜0.05);Fg与TPP呈正相关(r=0.61,P＜0.05).结论冠心病病人TPP及Fg含量越高,越易发生AMI;UA组TPP、Fg增高者可有血栓形成.TPP和Fg可作为预测冠心病病人发生新鲜血栓形成的指标.     

冠心病血管性假血友病因子和血小板α颗粒膜蛋白的变化及意义

为探讨冠心病患者血管性假血友病因子(VWF)和血小板α颗粒膜蛋白(CMP—140)的变化及意义,用酶联免疫吸附试验测定19例稳定性心绞痛(SA)、16例不稳定性心绞痛(UA)、7例急性心肌梗塞(AMI)患者和20例正常人的VWF和GMP—140.结果显示,冠心病患者VWF和CMP—140测值显著高于正常对照组(P<0.001),AMI和UA的VWF和GMP—140测值与SA比较有显著性差异(P<0.01),且AMI与UA之间上述指标也存在着显著性差异(P<0.05).提示,VWF和GMP—140水平的变化在冠心病的发生和发展起着重要的作用.     

Serum tumour necrosis factor-alpha,interleukin-2 and interleukin-10 activation in stable angina and acute coronary syndromes

BACKGROUND: Dynamic instability of coronary atherosclerotic plaque results in the development of both unstable angina and myocardial infarction. The aim of the study was to investigate the dynamics of serum concentrations of tumour necrosis factor (TNF)alpha, interleukin (IL)-10, and IL-2 in patients with myocardial infarction (MI) and unstable angina (UA) as compared to stable angina (SA) patients and healthy volunteers. METHODS: A total of 189 patients with coronary artery disease (CAD) were studied: 100 patients with SA (class II/III according to CCS), 57 patients with UA (Braunwald class IIIB; determinations at 6, 24, and 48 h after chest pain), and 32 patients with MI (determinations at admission, on the 7th and 30th days after MI). Twenty healthy volunteers acted as controls. RESULTS: Serum TNFalpha levels were elevated in all CAD groups (SA: 17.3+/-4; UA: 18.7+/-4; MI: 22.0+/-3 pg/ml; p<0.001) in comparison to the controls (8.3+/-1.4 pg/ml). However, the highest values were characteristic of MI patients, especially values obtained at admission (p<0.01 versus SA and UA). Mean serum concentrations of IL-2 were significantly higher in patients with MI and UA (89.6+/-40; 87.0+/-24 pg/ml, respectively; p<0.01) when compared to SA and the control group (58.3+/-49; and 51.5+/-39, respectively). Serum IL-10 levels were also higher in MI and UA patients. Levels of IL-2 and IL-10 measured following chest pain in unstable patients, as well as their consecutive determinations in MI patients did not show any change dynamics, that is, they were persistently elevated. CONCLUSIONS: When compared to stable CAD and healthy subjects, acute coronary syndromes are associated with long-term increase of serum concentrations of pro- and anti-inflammatory cytokines. It seems likely that sudden CAD progression leading to acute coronary syndromes is triggered/accompanied by prolonged immune activation.     

Platelets and white blood cell subpopulations among patients with myocardial infarction and unstable angina

Platelet (PLT)-endothelial cell and PLT-leukocyte interactions at lesion-prone sites might trigger a local inflammatory response early in the genesis of atherosclerosis and contribute to plaque destabilization leading to acute coronary syndromes (ACS). The aim of this study was to assess the PLT count, mean PLT volume (MPV), PLT mass, white blood cell (WBC; including eosinophils) and plasma interleukin (IL)-5, in patients with ACS and controls. PLT count, MPV, PLT mass, WBC and eosinophil percentage were determined in 167 consecutive patients with ACS (86 with acute myocardial infarction, AMI, and 81 unstable angina, UA) and 83 controls. Plasma IL-5 was measured in some patients and controls. Patients were considered in subgroups depending on smoking status and if they had or did not have diabetes mellitus (DM). The PLT count was lower in the UA and AMI groups although this did not always achieve significance. The MPV was significantly raised in all patient groups except in DM non-smokers with UA or AMI. All AMI patients had significantly higher WBC counts compared with controls. The percentage of eosinophils was lower in the UA and AMI groups although this did not always achieve significance. Plasma IL-5 levels were significantly increased in the UA and AMI groups. In conclusion, patients with ACS present with changes in the count of several cell types. These cells may become therapeutic targets and these changes may also act as markers of myocardial damage or prognosis.     

急性冠状动脉综合征患者外周血中脂联素水平与基质金属蛋白酶-9及其组织抑制因子-1关系的探讨

目的:探讨急性冠状动脉综合征患者(ACS)外周血中脂联素与基质金属蛋白酶-9(MMP-9)及基质金属蛋白酶组织抑制因子-1(TIMP-1)水平及其相关性的研究。方法:急性心肌梗死组19例,不稳定性心绞痛组31例,稳定性心绞痛组13例,正常对照组22例,检测各组外周血中脂联素、MMP-9、TIMP-1的浓度。各组间采用独立样本的t检验,各参数之间进行单因素的相关分析。结果:急性心肌梗死组、不稳定性心绞痛组分别与正常对照组比较:外周血清中脂联素的浓度、TIMP-1的浓度均显著降低(P<0.05～0.01),MMP-9/TIMP-1及MMP-9的浓度则均显著升高(P<0.05～0.01);急性心肌梗死组、不稳定性心绞痛组与稳定性心绞痛组比较,脂联素的浓度显著降低(P<0.05～0.01),MMP-9/TIMP-1升高(P<0.05～0.01);稳定性心绞痛组与正常对照组比较各指标间无明显差异。相关性分析中:脂联素与MMP-9之间无相关性(r=-0.248,P>0.05),脂联素与TIMP-1有显著相关性(r=0.408,P<0.01),脂联素与MMP-9/TIMP-1之间有显著相关性(r=-0.478,P<0.001)。结论:ACS患者中,脂联素的分泌减少,导致TIMP-1的分泌也减少,MMP-9/TIMP-1平衡破坏,可能是急性冠状动脉综合征发生的重要因素。     

CD40基因-1C/T多态性与急性冠脉综合症遗传易感性的研究

目的探讨CD40基因-1C/T多态性与急性冠脉综合症(ACS)的关系。方法采用聚合酶链反应限制性片段长度多态性(PCR-RFLP)技术检测127例急性心肌梗死(AMI)患者(AMI组)、162例不稳定心绞痛(UA)患者(UA组)和159名健康体检者(对照组)CD40基因-1C/T的基因型;酶联免疫吸附试验(ELISA)检测可溶性CD40(sCD40)水平。结果 CD40基因-1位点三种基因型及等位基因频率在AMI组、UA组和健康对照组中分布差异均有统计学意义(P=0.001),相对风险分析显示CC基因型患者AMI和UA的风险分别是TT基因型的6.919和3.073倍;携带C等位基因患者AMI和UA的风险分别是T等位基因型的2.421和1.692倍;sCD40水平在ACS组与对照组间、ACS组内不同基因型者间的分布差异均有统计学意义(P<0.01)。结论 CD40基因-1C/T多态性与ACS的发病具有相关性,C等位基因可能是ACS的遗传易感基因。