血浆可溶性CD40/CD40L在ACS风险评估中的意义

摘要

Objective To observe the alteration of plasma soluble CD40 and CD40L(sCD40,sCD40L)in patients with coronary heart disease (CHD),and to explore the clinical significance in risk assessment on acute coronary syndrome.Methods125 patients with CHD,64 patients with hypertension,diabetes and hyperlipidemia(group disease control),50 healthy volunteers(group healthy control)were measured for plasma sCD40 and sCD40L levels,high-sensitive C reactive protein(Hs-CRP)and troponin I(cTnI)concentrations. The correlation was analyzed between sCD40 or sCD40L and Hs-CRP or cTnI. Logistic regression analyse was used to assess the association of sCD40 and sCD40L with ACS risk.ResultsLevels of Hs-CRP, sCD40,sCD40L and cTnI in group CHD were significantly higher than that in two control groups(P<0.001),and in group ACS,levels of four markers were markedly higher than that in group SAP(P<0.001). In ACS patients,there was no statistical difference for sCD40 and sCD40L levels among patients with UAP,NSTEMI and STEMI(P>0.05). There was significantly positive correlation between sCD40 or sCD40L levels and Hs-CRP or cTnI level in all CHD patients and SAP patients(P<0.01),whereas there was no significant correlation for the markers among different ACS groups(P>0.05). Univariates analyse showed both sCD40 and sCD40L were the risk factors of ACS,whereas multivariates analyse revealed that only sCD40L was the independent risk factor of ACS in CHD patients(OR:1.556,95%CI:1.312-2.011,P<0.001).ConclusionPlasma CD40L is the risk factor of ACS in CHD patients,but sCD40 is not. Increased sCD40L level is useful for ACS prediction in CHD patients.%目的 观察冠心病(CHD)患者血浆可溶性CD40和CD40L(sCD40,sCD40L)水平的变化,探讨二者在急性冠脉综合征(ACS)风险评估中的意义.方法测定125例冠心病患者,64例"三高"症患者和50例健康体检者血浆sCD40、sCD40L,超敏C反应蛋白(Hs-CRP)以及心肌肌钙蛋白I(cTnI)水平,分析sCD40和sCD40L与后二者的相关性,以Logistic回归方法分析sCD40和sCD40L与ACS风险的关系.结果CHD组Hs-CRP浓度,血浆sCD40、sCD40L和cTnI浓度均显著高于疾病对照组和正常对照组(P<0.001),而ACS组四者水平均显著高于稳定型心绞痛(SAP)组(P<0.001).不稳定型心绞痛(UAP)、非ST段抬高性急性心肌梗死(NSTEAMI)和ST段抬高性急性心肌梗死(STEAMI)三组患者间sCD40和sCD40L水平差异无统计学意义(P>0.05).所有CHD和SAP患者sCD40和sCD40L水平与Hs-CRP和cTnI浓度均呈显著正相关(P<0.01),ACS患者sCD40和sCD40L与cTnI和Hs-CRP浓度相关性较低(P>0.05).单因素回归分析显示,sCD40和sCD40L均为ACS的危险因素,多因素回归分析显示,sCD40L为ACS的独立危险因素(OR:1.556,95%CI:1.312-2.011,P<0.001).结论血浆sCD40L是ACS的独立危险因素,sCD40为非危险因素,sCD40水平升高有助于预测CHD患者发生ACS的可能.