蛋白芯片法联检急性冠状动脉综合征患者血中细胞因子的意义

目的 探讨急性冠状动脉综合征(ACS)患者血中炎性细胞因子、炎性细胞相关因子及心肌损伤因子浓度的变化及临床意义.方法 运用蛋白芯片技术同步联检经冠状动脉造影及临床表现证实为ACS患者104例及对照者50例血清或血浆中10种细胞因子水平;同时对不稳定性心绞痛(UA)患者按Braunwald分级进行分析.结果 急性心肌梗死(AMI)组和UA组血清中C反应蛋白(CRP)、白介素(IL)-6、可溶性CD40L(sCD40L)、基质金属蛋白酶(MMP)-9、心脏型脂肪酸结合蛋白(H-FABP)、肌钙蛋白Ⅰ(cTnⅠ)及血浆中的IL-8、内皮素(ET)-1、可溶性血管细胞黏附分子(sVCAM)-1、氨基酸N末端脑钠肽原(NT-proBNP)浓度高于对照组,差异有统计学意义(P＜0.01);AMI组cTnⅠ[(11.08±10.49) μg/L]和H-FABP[(19.80±4.60)μg/L]浓度高于UA组[cTnⅠ:(0.69±0.18)μg/L,H-FABP:(4.12±2.45)μg/L,P＜0.01],而CRP、IL-6、MMP-9、sCD40L及ET-1浓度,两组比较差异无统计学意义;UA组MMP-9、sCD40L及H-FABP的浓度与Braunwald分级存在显著正相关(分别r=0.653,r=0.745,r=0.933,均P＜0.01).随着心绞痛严重程度的增加,MMP-9、sCD40L及H-FABP水平明显升高,心绞痛Ⅰ级＜心绞痛Ⅱ级＜心绞痛Ⅲ级(P＜0.01).结论 ACS患者血中存在多种细胞因子浓度异常,其中MMP-9、sCD40L、H-FASP的浓度与UA患者心绞痛严重程度存在良好的相关性.提示上述细胞因子参与和促使了ACS的发生、发展,为ACS的危险分层、预后判断提供了可能的分子标志物依据.

Circulating cytokine measurements by protein chips in patients with acute coronary syndrome

Objective To observe the feasibility of measuring multiple circulating cytokines by protein chips in patients with acute coronary syndrome(ACS).Methods Circulating cytokines were determined bv protein chips in 50 control cases and 104 ACS cases of unstable angina pectoris(UA,n=50)and acute myocardial infarction(AMI,n=54)cases.Results The levels of serum MMP-9,sCD40L,CRP,IL-6,H-FABP,cTnⅠ and plasma IL-8,NT-proBNP,sVCAM-1,ET-1 in ACS group were significantly higher than those in the control group(all P＜0.01).Serum H-FABP and cTnⅠ were significantly higher in AMI patients than in UA patients(P＜0.01).Serum MMP-9,sCD40L,CRP,IL-6 and plasma sVCAM-1,ET-1 tended to be higher in AMI patients as compared to UA patients(all P＞0.05).Serum MMP-9,sCD40L.and H-FABP were positively correlated with the severity of angina(r=0.653,r=0.745,r=0.933,P＜0.01,respectively).Serum MMP-9,sCD40L,and H-FABP increased in proportion to the levels of Braunwald angina classes in UA patients(angina class Ⅰ＜angina class Ⅱ＜angina class Ⅲ,P＜0.01).Conclusions Circulating cytokines were significantly increased in ACS patients and positively correlated to Braunwald angina classes in UA patients.