系统性红斑狼疮患者CD154的表达与炎症、心肌损伤指标的关系研究

目的测定系统性红斑狼疮（SLE）合并心肌损伤患者外周血单个核细胞CD154的表达水平，并与C反应蛋白（CRP）、心肌损伤指标之间进行相关分析，探讨CD154与患者炎症状态、心肌损伤的关系。方法①32例2010年4—10月在我院门诊或住院治疗的SLE患者，男2例，女30例。②给予心脏彩超测定左房前后径（LAD）、室间隔厚度（IVST）、左心室前后径（LVDd）、左心室重量指数（LYMI）、左心室射血分数（LVEF），心电图检查，免疫比浊法测定C反应蛋白（CRP）、全自动生化分析仪化学发光免疫分析法测定CK—MB、肌钙蛋白（cTnI），分离外周血单个核细胞，采用流式细胞仪分析检测CD154的表达水平。③根据心脏彩超、心电图检查、CK—MBII、肌钙蛋白结果，将有心肌损伤指标阳性的患者分为A组（20例），心肌损伤指标阴性的患者分为B组（12例）；20例健康志愿者为正常对照。④资料采用卡方检验，以Spearman相关法，即多元线性回归分析1个因变量和多个自变量之间的线性关系，P〈0．05为差异有统计学意义。结果①A组外周血单个核细胞CD154的表达水平为（29．1±10．8）％、CRP为（68．4±12．2）mg／L均明显高于B组（11．9±8．2）％、（36．9±11．5）meCL，P〈0．01；正常对照组外周血单个核细胞CD154的表达（5．9±2．2）％显著低于A、B组，P〈0．01。②A组CK-MBⅡ为（9．7±3．6n）ng／ml、cTnI为（0．43±0．21）n加nl、IVST为（11．8±3．2）mm、LVMI为（110．51±18．64）g／m^2显著高于B组CK—MBⅡ为（2．3±0．8）ng/ml、cTnI为（0．22±0．09）ng／ml、IVST（9．6±1．1）mm、LVMI（90．78±9．53）g／m2（P〈0．01）；A组LVDd（50．3±6．6）mm、LAD（32．4±5．4）mm、亦高于B组LVDd（46．4±3．1）mm、LAD（28．2±4．6）mm（P〈0．05）；A组LVEF（56．2±14．8）％显著低于B组LVEF（64．7±10．3）％（P〈0．01）。③患者外周血单个核细胞CD154的表达水平与CRP、CK—MBII、cTnI、LVDd、LVIMI、IVST、LAD呈正相关γ=0．343，γ=0．315，γ=0．437，γ=0．364，γ=0．448（均P〈0．01）；γ=0．266，γ=0．216（均P〈0．05）]；与LVEF呈负相关（γ=-0．346，P〈0．01）。结论SLE合并心肌损伤患者外周血单个核细胞CD154的表达水平，显著高于无心肌损伤患者，并与炎症、心肌损伤明显相关，提示CD154在SLE患者的心血管事件的发生发展中可能起到重要作用，可能会成为SLE患者心血管事件的重要预测指标，进一步研究可能会为SLE心肌损伤带来新的治疗方法。

Relationship among CD154 expression, inflammation and cardiac injury in patients with systemic lupus erythematosus

Objective To detect the CD154 expression on peripheral blood mononuclear cell in patients with systemic lupus erythematosus （SLE）, and analyse the relationship of CD154 expression, inflammation and cardiac injury. Methods （1） The sample consisted of 32 patients with SLE ,including 2 mate cases and 30 female cases.（2）To elevate their cardiac injury, echocardiography, electrocardiogram examination were taken, serum Creatine Kinase MB Ⅱ （CK-MB Ⅱ ） and cardiac troponin I （cTnI） were measured by chemiluminescent immunoassay on an automatic biochemical analyzer.The inflammational parameter C-reactive protein （CRP） was mesured by immunoturbidimetric assay. Echocardiographic parameters contained their left atrial diameter（LAD）, interventricular septal thickness（IVST）,the left ventricular internal diameter at end-diastole（LVD）,left ventricular mass index（LVMI） and the left ventricular ejection fraction（LVEF）. CD154 were measured by flow cytometertheir .（3）According the cardiac injury parameters, all patients were randomly divided into two groups： group A （20 cases） with cardiac injury,group B （12 cases） with no cardiac injury,and randomly selected 20 healthy persons to be normal control group. （4）Statistical analysis： datas were analysed by chi-square test and Spearman analysis. Results （1）CD154 expression on peripheral blood mononuclear cell and CRP in group A （29.1%±10.8% and 68.4mg/L±12.2mg/L） were significantly higher than those in group B （11.9%±8.2% and 36.9mg/L±11.5mg/L）（P〈0.01 ）;CD154 expression in normal control group （5.9%±2.2%）was siginifieantly lower than those in group A and B（P〈0.01 ）.（2）In group A, C K-MBⅡ（9.7±3.6）ng/ml,cTnI （0.43±0.21 ）ng/ml,IVST （ 11.8±3.2 ） mm,LVMI （110.51±18.64）g/m2 were signifieantly higher than those in group B（2.3±0.8）ng/ml,0.22ng/ml±0.09ng/ml,9.6mm± 1.1 mm,90.78g/m2±9.53g/m2 （P〈0.01 ） ; In group A, LVDd （50.3±6.6） mm and LAD （32.4±5.4） mm also higher than that in group B （46.4mm±3.1mm and 28.2mm±4.6mm）（P〈0.05）;In group A, LVEF （56.2±14.8）% was signifieantly lower than that in group B （64.7±10.3） % （P〈0.01）. In group A, CD154 expression on peripheral blood mononuelear cell had a positive correlation with CPR, CK-MB Ⅱ, cTnI, LVDd, LVIMI, IVST and LAD （γ=0.343, γ=0.315, γ=0.437, γ=0.364, γ=0.448, all P〈0.01 ）, γ=0.266,γ=0.216 （P〈0.05）, had a negative correlation with LVEF （γ=-0.346,P〈0.01）. Conclusion In SLE patients with eardiae injury, the CD154 expression on peripheral blood mononuclear cell was significantly higher than that in SLE patients without eardiae injury,and had signifieantly correlation with parameters of cardiac injury,which showed CD154 expression may play an important role and beeome a predictor in progress of eardiovaseular disease.