急性心肌梗死患者血清可溶性CD40配体和纤维蛋白原的改变及其临床意义

目的 观察急性心肌梗死患者血清可溶性CD40配体(sCD40L)水平和血浆纤维蛋白原(Fg)的变化以及与临床预后的关系.方法 采用酶联免疫吸附法测定60例急性心肌梗死患者血清sCD40L水平,用全自动血凝分析仪测定血浆Fg,患者出院后随访2年,观察心血管事件.结果 急性心肌梗死患者sCD40L水平(15.36±7.32)μg/L显著高于正常对照组(5.79±2.78)μg/L(P<0.001).急性心肌梗死患者中Fg水平(4.60±1.37)g/L显著高于正常对照组(3.03±0.82)g/L(P<0.001).发生心血管事件患者的sCD40L(18.14±6.34)μg/L和Fg(4.97±1.33)g/L显著高于无心血管临床事件患者的sCD40L(14.38±6.67)μg/L和Fg(4.20±1.24)g/L(P<0.05).sCD40L水平≥14.5 μg/L或Fg≥4.4 g/L的患者的心血管事件发生增多(P<0.05).合并糖尿病的急性心肌梗死患者sCD40L水平(18.38±6.71) μg/L显著高于不合并糖尿病的急性心肌梗死患者(14.46±6.48)μg/L(P<0.05).相关性分析显示在AMI患者中sCD40L与Fg正相关(r=0.27,P<0.05),Fg与左室射血分数负相关(r=-0.319,P<0.05).结论 急性心肌梗死患者血清sCD40L水平和Fg升高,sCD40L和Fg明显升高的患者发生心血管事件的风险明显升高,糖尿病是sCD40L升高的临床危险因素,sCD40L和Fg是急性心肌梗死患者的预后指标,在急性心肌梗死的病理生理过程中起重要作用.

Soluble CD40 Ligand and fibrinogen in acute myocardial infarction

Objective To observe the changes of serum soluble CD40 ligand (sCD40L) and fibrinogen in acute myocardial infarction (AMI) patients and to investigate the clinical predictive value of increased serum sCD40L and fibrinogen. Methods Serum sCD40L level of 60 AMI patients was determined by enzyme-linked im-munosorbent assay (ELISA). Plasma level of fibrinogen was measured. The patients were followed up for 2 years af-ter discharge from the hospital and were observed for cardiovascular event. Results AMI patients had higher sCD40L and fibrinogen levels than those of controls (15.36±7.32) μg/L vs. (5.79±2.78) μg/L, (4.60±1.37)g/L vs. (3.03±0.82) g/L,P<0.001] ,which were significantly higher in the patients experiencing cardio-vascular event than those without cardiovascular event (18.14±6.34) μg/L vs. (14.38±6.67) μg/L and (4.97±1.33)g/L vs. (4.20±1.24} g/L] (P<0.05). The patients with sCD40L≥14.5 μg/L or fibrinogen≥ 4.4 g/L experienced increased risk of adverse cardiovascular events (P<0.05). In AMI patients, sCD40L level was significantly higher in patients with diabetes than in nondiabetics (18.38±6.71) μg/L vs. (14.46±6.48) μg/L, P<0.05)]. Fibrinogen level was related to sCD40L (r=0.27, P<0.05) and LVEF(r=-0.319, P<0.05). Conclusion Increased sCD40L and fibrinogen levels,which maybe related to the pathogenesis of AMI,can be found in AMI patients and can indicate an independent increased risk of major adverse cardiovascular events. Diabetes is independently associated with elevated sCD40L level in AMI patients.