Toll样受体4在冠状动脉粥样斑块中的表达及其与冠心病猝死的关系

目的 探讨Toll样受体4(TLR4)在冠状动脉粥样硬化斑块中的表达及其与冠心病猝死的关系.方法 从本教研室2003-2006年尸检档案中挑选病例及心脏标本、蜡块共75例.分为冠心病猝死组(28例)、冠心病非猝死组(简称冠心病组,28例)和对照组(无明显冠状动脉粥样硬化者,19例).用免疫组化SABC法、图像分析技术和SPSS14.0统计学软件检测TLR4在不同组的冠状动脉粥样硬化斑块内表达的阳性细胞面积/扫描面积(R)和平均光密度值(A)及各组间的差异.结果 猝死组中13例(46.4%)TLR4蛋白强阳性表达,11例(39.3%)为较强阳性表达,4例(14.3%)为较弱阳性表达.冠心病组中8例(28.6%)呈较弱的阳性表达,17例(60.7%)很微弱的阳性表达,3例(10.7%)未见阳性表达.对照组冠状动脉内膜及轻度增厚处呈阴性表达.猝死组冠状动脉粥样硬化斑块中TLR4表达的A值(1.140±0.101)和R值(0.0269±0.0027)均高于冠心病组(A值:0.719±0.205,R值:0.0085±0.0007;均P＜0.01)和对照组(A值:0.481 ±0.033,R值:0.0046±0.0004;均P＜0.01).冠心病组的A值也高于对照组(P＜0.05),而R值差异无统计学意义.结论 冠状动脉粥样硬化斑块中TLR4表达情况可作为冠心病猝死者病理诊断的一个重要指标,也可为临床防治冠心病和急性冠状动脉综合征提供一个新的思路.

Toll-like receptor 4 expression in the coronary atherosclerotic plaques of patients died from sudden cardiac death

Objective To investigate the Toll like receptor 4(TLR4)expression in the coronary atheroselerotic plaques in patients died from sudden cardiac death(SCD)or non SCD.Methods Autopsied coronary artery samples from 75 patients died from SCD(n=28),non-SCD(n=28)or non-CHD(n=19)were examined and the R value(positive cells'areas/scanning areas)and A value(average optical density)of TLR4 expression in the coronary arteries were detected qualitatively by the immunohistochemistry(SABC method)and image analysis technologies.Results SCD group:13(46.4%)cases showed strong positive expression of TLR4;11(39.3%),positive expression;4(14.3%),weak positive expression.CHD group:8(28.6%)cases showed weak positive expression;17(60.7%),very weak positive expression;3 (10.7%),no positive expression.There was no positive expression of TLR4 in non-CHD samples.A (1.140±0.101)and R value(0.0269±0.0027)in SCD group were significantly higher than in non-SCD and control groups(all P＜0.01).A value was siginificantly higher in CHD group(0.719±0.205)than that in control group(0.481±0.033,P＜0.05)while R value(0.0085±0.0007,0.0046±0.0004)was similar between the groups(P＞0.05).Conclusion The increased positive expressive of TLR4 in the atherosclerotic plaque can be regarded as an important pathological marker of SCD.