可溶性CD40L在评价冠状动脉粥样硬化斑块易损伤中的意义

目的：探讨血清可溶性白细胞分化抗原40配体（sCD40L）在评价冠状动脉粥样硬化斑块易损性中的意义，并探讨sCD40L水平和冠状动脉狭窄程度及其与C-反应蛋白（CRP）和血沉（ESR）的相关性。 方法：按照WHO关于冠心病的诊断标准，并结合冠状动脉造影（CAG）结果，选择84例冠心病（CHD）患者和20例非冠心病患者（NCHD）作为研究对象。84例CHD分为3组：急性心肌梗死（AMI）30例， 不稳定心绞痛（UA）30例 ，稳定性心绞痛（SA）24例。4组患者均在入院当天采用双抗体夹心酶标免疫吸附法（ELISA）测定血清标本中的sCD40L水平（μg/L）。并进行CAG检查，确定冠状动脉病变支数和Jenkins评分。同时测定ESR、CRP。 结果：4组患者血清sCD40L水平存在明显差异（P<0.01）。AMI组sCD40L水平［（8.48±4.13) μg/L］明显高于SA组［（4.36±2.68) μg/L］（P<0.01）和NCHD组［（4.12±1.96) μg/L］（P<0.01）；UA组sCD40L水平［（8.72±4.26) μg/L］明显高于SA组和NCHD组（P<0.01）；UA组sCD40L水平轻微高于AMI组，但无显著差异（P>0.05）；SA组sCD40L水平轻微高于NCHD组，但无显著差异（P>0.05）。冠心病患者血清sCD40L水平与Jenkins评分呈显著正相关关系（r=0.524，P<0.01）。sCD40L水平与ESR和CRP显著相关（r=0.722，P<0.01和r=0.734，P<0.01）。 结论：AMI和UA组患者血清sCD40L水平明显高于SA和NCHD患者，提示sCD40L水平可能反映冠状动脉粥样硬化斑块的易损性。sCD40L水平随着冠脉病变支数和Jenkins积分的增加而升高，提示sCD40L可能有促进冠状动脉硬化的作用。sCD40L与ESR和CRP具有显著相关关系。

Significance of soluble CD40 ligand in the vulnerability of coronary atherosclerotic plaque

AIM: To evaluate the significance of serum soluble CD40 ligand (sCD40L) in the vulnerability of coronary atherosclerotic plaque, the relationship between the level of sCD40L and the stenosis degree of the coronary artery by the coronary angiography (CAG), and other inflammatory factors. METHODS: According to WHO diagnostic criterior of coronary heart disease (CHD) and the results of CAG, 84 cases of CHD and 20 cases of non-CHD (NCHD) were included in this study. 84 cases of CHD were divided into three groups: 30 cases in acute myocardial infarction (AMI) group, 30 cases in unstable angina (UA), 24 cases in stable angina (SA). The sera levels of sCD40L in four groups were detected by the enzyme-linked immunosorbent assay (ELISA) and the results were expressed with μg/L. CAG were all conducted in four cases and the results were further evaluated by Jenkins score. ESR and CRP were detected at the same time. RESULTS: The sera levels of sCD40L in four groups were significantly different (P<0.01). The level of sCD40L in AMI group (8.48±4.13) μg/L was higher than that in SA group (4.36±2.68) μg/L, P<0.01 and NCHD group (4.12±1.96) μg/L, P<0.01. The level of sCD40L in UA group (8.72±4.26) μg/L was higher than that in SA group and NCHD group (P<0.01). The level of sCD40L in UA group was slightly higher than that in AMI group, but the difference of two group is not significant (P>0.05). The level of sCD40L in SA group was slightly higher than that in NCHD group, but the difference of two group is not significant (P>0.05). The sera levels of sCD40L in CHD were significantly and positively correlated with Jenkins score (r=0.524, P<0.01). The sera level of sCD40L was positively correlated with the levels of CRP and ESR. CONCLUSION: The sera levels of sCD40L in the patients with various types of CHD are significantly different. The level of sCD40L in the patients with AMI and UA are significantly higher than those in SA and NCHD groups, which may reflect the vulnerability of coronary atherosclerotic plaque. The sera levels of sCD40L is increased with the increasing number of diseased coronary branches and Jenkins score, suggesting that sCD40L promotes atherosclerosis and also can be used as a parameter to predict pathological severity of coronary atherosclerosis. The level of sCD40L is obviously correlated with the levels of CRP and ESR.