不稳定性心绞痛患者基质金属蛋白酶-1与细胞分化抗原40配体的研究

目的探讨自细胞分化抗原40配体（CD40L）介导基质金属蛋白酶-1（MMP-1）的表达与分泌在不稳定性心绞痛（UA）发病机制中所起的作用，以及MMP-1在UA患者危险度分层及预后价值中的作用。方法选择UA患者组64例，并按Braunwald分级分为Ⅰ、Ⅱ、Ⅲ级，选择稳定性心绞痛（SA）患者组56例及健康对照组40例，采用酶联免疫吸附法分别测定各组血清可溶性CD40L（sCD40L）、MMP-1的水平，分析UA组MMP-1与sCD40L之间的相关性，同时分析MMP-1水平与心血管事件发生率的相关性。结果（1）UA患者组MMP-1水平（53．53±18．25）μg／L显著高于SA患者组（31．28±13．64）μg／L（P〈0.01）及对照组（11．58±9．83）μg／L（P〈0．05）；sCD40L水平（3．21±2．78）μg／L显著高于sA患者组（1．83±1．37）μg／L（P〈0.01）及对照组（1．19±1．05）μg／L（P〈0．01）。（2）UA患者组MMP-1与sCD40L水平之间呈显著正相关（r=0．642，P〈0．01）。（3）UA患者组MMP-1水平升高组发生心血管事件明显高于MMP-1水平低者组（P〈0．01）。结论（1）UA患者外周血sCD40L、MMP-1水平升高，MMP-1与CD40L之间呈显著正相关，提示冠状动脉粥样硬化斑块的破裂可能与CD40L介导MMP-1的表达与分泌有关。（2）UA患者MMP-1水平与心血管事件发生率之间呈正相关性，提示MMP-1可作为UA患者危险度分层及预后有价值的生化指标。

The relationship between level of matrix metalloproteinase-1 and soluble CD40 ligand in patients with unstable angina

Objective To explore the role of expression and secretion of matrix metalloproteinase（MMP-1） mediated by CD40 ligand（CD40L） in pathogenesis in patient with unstable angina（UA） and to investigate the prognostic value and risk stratification of MMP-1 in UA. Methods Concentration of serum soluble CD40L and MMP-1 were measured by enzyme-linked immunosorbent assay in 64 UA patients, 56 patients with stable angina （SA） and 40 controls. The 64 UA patients were divided into Braunwald＇s grades Ⅰ , Ⅱ and Ⅲ. The correlations between MMP-1 and CD40L, and between MMP-1 levels and occurrence of cardiovascular events were analyzed. Results （1） Serum levels of MMP-1 were significantly higher in UA patients （55.53 ± 18. 25）μg/L] than in SA patents （31. 38±13.64）μg/L,P〈0. 01] and controls （11.58± 9.83）μg/L,P〈0. 05];serum levels of CD40L were significantly higher in UA patients （3. 21 ± 2. 78） μg/L] than in SA patients（ 1. 83± 1. 37） μg/L, P 〈 0. 01] and controls （1.19±1.05）μg/L,P〈0. 01]. （2） MMP-1 level was positively correlated with CD40L level in UA patients （r=0. 642,P〈0. 01）, MMP-1 was strongly correlated with CD40L. （3） The incidences of cardiovascular events were signicantly higher in patients with elevated MMP-1 levels than in patients with low levels of MMP-1. Conclusion （1） The blood levels of CD40L and MMP-1 were high in UA patients, suggesting that the elevated MMP-1 level may be mediated by CD40L in the rupture of coronary artery plaque. （2） The levels of MMP-1 were pos-itively correlated with the occurrence of cardiovascular events in UA patients, suggesting that the level of MMP-1 is a highly sensitive and specific biochemical marker for assessing risk stratification and prognosis.