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目的:探讨趋化因子CCL21及其受体CCR7与冠状动脉(冠脉)易损斑块之间的关系。方法:选择行冠脉造影(CAG)患者180例,其中急性冠脉综合征(ACS)患者60例(ACS组),稳定型心绞痛(SAP)患者60例(SAP组),CAG正常且没有其他粥样硬化证据患者60例(对照组)。ACS组和SAP组患者在CAG后行血管内超声(IVUS)检查。采用双抗体夹心酶联免疫吸附法(ELISA法)检测血清趋化因子CCL21及高敏C反应蛋白(hs-CRP)的浓度,用流式细胞术测定外周淋巴细胞表面CCR7的表达水平。结果:血清趋化因子CCL21浓度与外周淋巴细胞CCR7的表达在备组之间有显著差异(均P<0.05);应用CCL21判断ACS的ROC曲线下面积,大于应用hs-CRP判断ACS的ROC曲线下面积[(0.803±0.027):(0.71 6±0.021),P<0.01]。IVUS发现ACS组主要为脂质性斑块(65%),而SAP组主要为纤维性斑块(57%),脂质斑块仅占13%,两组差异有统计学意义(P<0.01);ACS组斑块负荷和血管重构指数明显大于SAP组(P<0.01);利用IVUS测定的斑块负荷与趋化因子CCL21浓度呈显著正相关(r=0.795,P<0.01),与外周淋巴细胞表面CCR7的表达呈显著负相关(r=-0.693,P<0.01)。结论:趋化因子CCL21及其受体CCR7与冠脉斑块易损性密切相关,较hs-CRP具有更高的早期诊断和判断预后的价值。
Objective: To investigate the relationship between chemokine CCL21 and its receptor CCR7 and vulnerable coronary artery (coronary artery) plaque. Methods: One hundred and eighty patients with coronary artery angiography (CAG) were enrolled in this study. Sixty ACS patients (ACS group) and 60 patients with stable angina pectoris (SAP) had normal CAG and no other 60 cases of atherosclerosis evidence patients (control group). Patients in ACS group and SAP group underwent intravascular ultrasound (IVUS) examination after CAG. Serum chemokine CCL21 and high-sensitivity C-reactive protein (hs-CRP) concentrations were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA), and the expression of CCR7 on peripheral lymphocytes was detected by flow cytometry. Results: There was significant difference between CCL7 concentration and CCR7 expression in peripheral lymphocytes (all P <0.05). CCL21 was used to determine the area under ROC curve of ACS, which was greater than that of hs-CRP Under the area [(0.803 ± 0.027) :( 0.71 6 ± 0.021), P <0.01]. IVUS found that the main group of lipid-based plaques ACS (65%), while the SAP group mainly fibrous plaque (57%), lipid plaque accounted for only 13%, the difference between the two groups was statistically significant (P <0.01 ). The plaque load and vascular remodeling index in ACS group were significantly higher than those in SAP group (P <0.01). The plaque load and chemokine CCL21 concentration were significantly correlated with IVUS (r = 0.795, P <0.01) There was a significant negative correlation between the expression of CCR7 on peripheral lymphocytes (r = -0.693, P <0.01). CONCLUSION: The chemokine CCL21 and its receptor CCR7 are closely related to the vulnerability of coronary plaque, which has higher value of early diagnosis and prognosis than hs-CRP.