急性冠状动脉综合征患者PCI术后血浆妊娠相关蛋白A和CD40L的变化及其临床意义

目的:探讨急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)手术后血浆CD40L和妊娠相关蛋白-A(PAPP-A)水平的变化,以及PAPP-A对术后6个月内心血管事件和再狭窄发生的预测价值.方法:检测43例ACS患者(不稳定型心绞痛25例,急性心肌梗死18例)和25例稳定型心绞痛患者PCI术后CD40L和PAPP-A水平.采用酶联免疫吸附法(ELISA)检测其血浆中CD40L和PAPP-A的水平.并随访患者术后6个月内主要心血管事件(心绞痛、心肌梗死及死亡)发生情况,分析它们之间的关系.36例病人术后6月复查了冠脉造影,分析其支架内再狭窄情况.结果:ACS组(包括不稳定型心绞痛和急性心肌梗死病人)术后血浆CD40L和PAPP-A水平比稳定型心绞痛组高.直线相关分析发现ACS组患者CD40L与PAPP-A之间呈显著正相关(r=0.64,P＜0.01).手术后6月内有心血管事件组术后PAPP-A较无心血管事件组高.手术后6月内有再狭窄的病人术后PAPP-A水平较无再狭窄的病人高,且PAPP-A水平与PCI术后冠状动脉后期内径丢失指数呈正相关.结论:急性冠脉综合征病人CD40L和PAPP-A水平较稳定型心绞痛高,两者有显著相关.CD40L水平升高与ACS的关系可能与其刺激PAPP-A的表达增加有关.急性冠脉综合征病人PCI术后的PAPP-A水平的检测可以预测术后6月内主要心脏事件和再狭窄的发生.

Changes of plasma CD40L and PAPP-A in patients withacute coronary syndrome after the PCI operation

Objective To observe the changes and significance of plasma CD40L and pregnancy-associated plasma protein-A(PAPP-A)in acute coronary syndrome(ACS)patients after percutaneous coronary intervention(PCI)operation.Methods According to the occurrence of primary heart events or restenosis 6 months after the PCI,68 patients were divided into the ACS group and the stable anginapectoris(SAP)group.Plasma CD40L and PAPP-A after the PCI operation were measured and compared.Thirty-six patients underwent repeated angiography after the PCI.Their baseline and follow up angiograms were compared by quantitative coronary angiography to assess the incidence of restenosis.Results CD40L and PAPP-A after the PCI operation were higher in the ACS group than that in the SAP group.The group having primary heart events within 6 months had higher level of PAPP-A after the PCI.The group having restenosis 6 months had higher level of PAPP-A after the PCI.The change of later loss index of coronary artery lumen diameter was correlated with PAPP-A level after the PCI.Conclusion CD40L and PAPP-A were higher in the ACS group,indicating the possible mechanism by which CD40L facilitates the plaque rupture via up-regulating the PAPP-A expression.Plasma PAPP-A level after the PCI possibly forcasts the occurrence of primary heart events or restenosis within 6 months.