接受择期PCI术的急性冠脉综合征患者外周血单核细胞Toll样受体4表达及强化阿托伐他汀治疗对其的影响

目的：探讨接受择期经皮冠状动脉介入治疗( PCI )术的急性冠脉综合征( ACS)患者外周血单核细胞Toll样受体4(TLR4)表达水平与ACS发生和冠脉病变严重程度的相关性,同时观察强化阿托伐他汀治疗对TLR4表达的影响。方法选取行择期PCI术的ACS患者75例,随机分为强化组和常规组,强化组入院后予以阿托伐他汀40 mg/d,PCI术后持续,4周后减量至20 mg/d；常规组入院后予以阿托伐他汀20 mg/d,PCI术后持续,4周后仍维持20 mg/d。采用流式细胞仪检测入院时和4周后患者外周血单核细胞 TLR4表达水平的变化,采用Gensini评分反映冠脉病变严重程度。同时选择健康体检者20例作为正常对照组。结果①与正常对照者相比,ACS患者外周血单核细胞TLR4表达明显升高,急性心肌梗死( AMI)患者明显高于不稳定性心绞痛( UP)患者,3支病变者明显高于1支、2支病变者,差异均有统计学意义(P<0．01)；相关分析和多元逐步线性回归分析结果显示ACS类型、冠脉狭窄积分、冠脉病变支数与外周血单核细胞TLR4表达水平呈正相关性,对其影响最大( P<0．05)。②阿托伐他汀治疗4周后两组外周血单核细胞TLR4表达、总胆固醇( TCH )、低密度脂蛋白胆固醇( LDL-C)、甘油三脂( TG)明显降低,高密度脂蛋白胆固醇( HDL-C)明显升高,差异均有统计学意义( P<0．01)；与常规组相比,强化组外周血单核细胞TLR4表达、TCH、LDL-C降低更显著,HDL-C升高更显著,差异均有统计学意义( P<0．01)。结论外周血单核细胞TLR4表达增加与ACS发生和冠脉病变严重程度密切相关,强化阿托伐他汀治疗明显降低行择期PCI术的ACS患者外周血单核细胞TLR4表达。

Change of TLR4 in patients with acute coronary syndrome undergoing selective PCI and intensive atorvastatin treatment

Objective To investigate the change of Toll-like receptor 4 ( TLR4 ) in patients with acute coronary syndrome (ACS) undergoing selective percutaneous coronary intervention (PCI) and intensive atorvastatin treat-ment. Methods Twenty patients with AMI and 55 patients with unstable angina pectoris ( UP) undergoing selec-tive PCI, and 20 healthy subjects as controls were enrolled, and the TLR4 levels of their peripheral blood CD14 +cells were detected. Then these patients were divided into routine-dose atorvastatin group ( RD group) and inten-sive-dose atorvastatin group ( ID group) , and the TLR4 levels after 4 weeks were detected. Results ①Compared with controls, the TLR4 levels in ACS patients were significantly higher, and the levels of TLR4 in AMI and triple branch lesions groups were significantly higher than them in UP, single and double branch lesion groups ( P <0. 01). Correlation analysis and stepwise multiple linear regression showed that ACS category, Gensini scores and branches of coronary arteries lesion were were positively associated with the levels of TLR4 ( P<0. 05 ) .② After treatment for 4 weeks, the levels of TLR4, total cholesterol (TCH), low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) decreased, and high density lipoprotein cholesterol (HDL-C) increased significantly in ei-ther group (P<0. 01), compared with RD group, the TLR4 levels, TCH and LDL-C in ID group were ignificantly decreased, and HDL-C significantly increased ( P <0. 01 ) . Conclusion The TLR4 level of peripheral blood CD14 + cell is closely related with ACS and the severity of coronary artery lesion. Intensive atorvastatin treatment can decrease significantly TLR4 level of the patient with ACS undergoing selective PCI.