冠状动脉斑块形态与CD40配体及妊娠相关蛋白酶-A的关系  

Association between CD40 ligands pregnancy-associated plasma protein-A and angiographic morphology of coronary lesions in patients with coronary heart disease

作　　者：李旭平[1] 张志辉[1] 周胜华[1] 刘启明[1] 胡信群[1] 祁述善[1] 

机构地区：[1]长沙中南大学湘雅二医院心内科,410011

出　　处：《中国介入心脏病学杂志》2005年第1期28-30,共3页Chinese Journal of Interventional Cardiology

基　　金：湖南省自然科学基金课题 (0 2JJY2 0 43 )

摘　　要：目的　检测经冠状动脉造影显示为Ⅱ型斑块的冠心病患者血浆中CD4 0配体 (CD4 0L)和妊娠相关蛋白酶 A(PAPP A)水平 ,从临床角度探讨斑块破裂的原因。方法　对 6 8例经冠状动脉造影证实的冠心病患者的冠状动脉斑块形态进行分型。根据斑块形态 ,患者分为 4组 :Ⅰ型病变组 (表面光滑 ,n =1 9) ,Ⅱ型病变组 (表面不规则 ,n =33) ,Ⅲ型病变组 (长段表面不规则 ,n =1 6 ) ,另 2 5例冠状动脉造影正常的患者为对照组。所有患者检测血浆CD4 0L、PAPP A、心肌肌酸激酶 (CK)及肌酸激酶同工酶 (CK MB)。结果　Ⅱ型病变组血浆CD4 0L水平 [(3 2 1± 2 0 8)mg/L]显著高于Ⅰ型病变组[(1 0 3± 0 98)mg/L ,P <0 0 1 ]、Ⅲ型病变组 [(1 2 3± 0 88)mg/L ,P <0 0 5 ]和对照组 [(1 0 1± 0 94 )mg/L ,P <0 0 1 ]。Ⅱ型病变组血浆PAPP A[(1 6 8± 7 2 )mU/L]显著高于Ⅰ型病变组 [(7 3± 4 1 )mU/L ,P <0 0 1 ]、Ⅲ型病变组 [(8 9± 4 9)mU/L ,P <0 0 5 ]和对照组 [(7 1± 4 4)mU/L ,P <0 0 1 ]。Ⅱ型病变组血浆CD4 0L与PAPP A呈显著正相关 (r =0 44 6 ,P <0 0 1 )。结论　冠状动脉造影显示斑块破裂的冠心病患者血浆CD4 0L、PAPP A水平明显升高 ,且CD4 0L与PAPP A呈正相关。提示CD4 0L可能通过上调PAPPObjective The aim of this study was to examine plasma levels of CD40 ligands (CD40L) and pregnancy-associated plasma protein-A in patients with angiography type Ⅱ lesions (representing plaque rupture with or without thrombosis), and to evaluate the role of PAPP-A in the development of plaque disruption. Methods The morphology of the plaques in 68 patients was studied and analyed by means of coronary angiography. According to the morphology of the plaques, the patients were divided into type Ⅰ group (smooth borders, n=19), type Ⅱ group (irregular lesions, n=33), and type Ⅲ group (long lesions, n=16). The plasma level of CD40L, PAPP-A, creatine kinase (CK), and MB isoenzyme of CK (CK-MB) was measured in all the patients. Results Mean plasma CD40L [(3.21±2.08)mg/L] in type Ⅱ group was significantly higher than that in the type Ⅰ group [(1.03±0.98)mg/L, P<0.01], type Ⅲ group [(1.23±0.88) mg/L, P<0.05] and also the controls group [(1.01±0.94)mg/L, P<0.01]. Mean plasma PAPP-A in type Ⅱ group [(16.8±7.2)mU/L] was significantly elevated than that in the type Ⅰ group [(7.3±4.1)mU/L, P<0.01], type Ⅲ group [(8.9±4.9)mU/L, P<0.05], and the control group [(7.1±4.4)mU/L, P<0.01]. The plasma level of CD40L and PAPP-A was positively correlated in patients with type Ⅱ leison (r=0.446, P<0.01). Conclusion Plasma levels of CD40L and PAPP-A increased in patients with coronary plaque rupture and had a positive correlation. These results indicate the possible mechanism by which CD40L facilitates the plaque rupture via up-regulating the PAPP-A expression.

关 键 词：血浆 CD40L PAPP-A 相关蛋白 对照组 冠心病患者 冠状动脉斑块形态 病变 经冠状动脉造影 CD40配体 

分 类 号：R541.4[医药卫生—心血管疾病] R714[医药卫生—内科学]