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目的探讨急性冠脉综合征(ACS)患者体内血小板活化、CD40配体(CD40L或CD154)的表达及可溶性CD40L(sCD40L)变化的临床意义。方法 71例住院确诊为冠心病的患者中,稳定性心绞痛(SA)19例,不稳定性心绞痛(UA)23例,急性心肌梗死(AMI)29例。另选对照20例。应用直接免疫荧光流式细胞术测定各组病例血小板表达CD40L和P-选择素(CD62P)的水平,用酶联免疫吸附法测定血清sCD40L水平。结果 ACS患者(包括UA组和AMI组)血小板表达CD40L和CD62P的水平及血清sCD40L水平明显高于SA患者和对照组(P<0.05),UA组和AMI组、SA组和正常对照组之间的差异均无统计学意义(P>0.05)。sCD40L水平与低密度脂蛋白(LDL)、脂蛋白a水平成正相关。结论 CD40L可能参与了ACS的发生,且可能反映动脉粥样斑块的不稳定。
Objective To investigate the clinical significance of platelet activation, expression of CD40 ligand (CD40L or CD154) and soluble CD40L (sCD40L) in patients with acute coronary syndrome (ACS). Methods Totally 71 patients with coronary heart disease diagnosed as CHD were enrolled in this study. Among them, 19 were stable angina pectoris (SA), 23 were unstable angina pectoris (UA) and 29 were acute myocardial infarction (AMI). Alternative control in 20 cases. The levels of CD40L and P-selectin (CD62P) on platelets were measured by direct immunofluorescence flow cytometry. Serum sCD40L levels were determined by enzyme-linked immunosorbent assay. Results The level of platelet CD40L and CD62P and the level of serum sCD40L in ACS patients (including UA group and AMI group) were significantly higher than those in SA patients and control group (P <0.05). Between UA group and AMI group, SA group and normal control group The difference was not statistically significant (P> 0.05). The level of sCD40L was positively correlated with the levels of low density lipoprotein (LDL) and lipoprotein a. Conclusion CD40L may be involved in the occurrence of ACS, and may reflect the atherosclerotic plaque instability.