急性冠脉综合征患者CD40配体的表达及其临床意义

目的探讨急性冠脉综合征（ACS）患者体内血小板活化、CD40配体（CD40L或CD154）的表达及可溶性CD40L（sCD40L）变化的临床意义。方法 71例住院确诊为冠心病的患者中,稳定性心绞痛（SA）19例,不稳定性心绞痛（UA）23例,急性心肌梗死（AMI）29例。另选对照20例。应用直接免疫荧光流式细胞术测定各组病例血小板表达CD40L和P-选择素（CD62P）的水平,用酶联免疫吸附法测定血清sCD40L水平。结果 ACS患者（包括UA组和AMI组）血小板表达CD40L和CD62P的水平及血清sCD40L水平明显高于SA患者和对照组（P〈0.05）,UA组和AMI组、SA组和正常对照组之间的差异均无统计学意义（P〉0.05）。sCD40L水平与低密度脂蛋白（LDL）、脂蛋白a水平成正相关。结论 CD40L可能参与了ACS的发生,且可能反映动脉粥样斑块的不稳定。

Expression of CD40 Ligand in Patients with Acute Coronary Syndrome and Its Significance

Objective To investigate the clinical significance of platelets activation in vivo,CD40 ligand（CD40L） expressed on platelet and soluble CD40 ligand（sCD40L） in patients with acute coronary syndrom（ACS）.Methods Seventy-one patients with coronary disease admitted in our hospital were devided into three groups of stable angina,unstable angina and acute myocardial infarction.Twenty healthy people were taken as the controls.The expressions of CD40L and CD62P on platelet were analyzed by direct-immonofluorescence flow cytometry and serum sCD40L levels were measured by ELISA.Results The expressions of CD40L and CD62P on platelet and serum sCD40L were significantly higher in patients with ACS including UA and AMI（P0.01）than those in patients with SA and the controls,while no significant difference was found between the patients with SA and the controls or between the patients with UA and with AMI.A significant correlation was observed between sCD40L and LDL,Lp（a）.Conclusion The elevated CD40L on activated platelet and sCD40L in ACS suggest the possible participation of CD40L in the pathogenesis of ACS,which may represent a marker of plaque unstability.