CD40配体、妊娠相关血浆蛋白A和丙二醛化低密度脂蛋白的变化与冠状动脉斑块破裂相关性  

Relation of CD40 Ligand,Pregnancy-Associated Plasma ProteinA and Malondialdehyde-Modified Low Density Lipoprotein to Angiographic Morphology of Coronary Lesions in Patients with Coronary Heart Disease

作　　者：张志辉[1] 李旭平[2] 周胜华[2] 祁述善[2] 

机构地区：[1]中南大学湘雅三医院心内科,湖南省长沙市410013 [2]中南大学湘雅二医院心内科,湖南省长沙市410011

出　　处：《中国动脉硬化杂志》2007年第2期129-132,共4页Chinese Journal of Arteriosclerosis

摘　　要：目的观察CD40配体、妊娠相关血浆蛋白A和丙二醛化低密度脂蛋白在冠状动脉造影显示为Ⅱ型斑块的冠心病患者血浆中的变化与相关性。方法收集冠状动脉造影为冠心病患者85例,根据斑块形态,将冠心病患者分为三组,即Ⅰ型病变(表面光滑)组(n=31),Ⅱ型病变(表面不规则)组(n=35)及Ⅲ型病变(长段不规则)组(n=19),冠状动脉造影正常的25例为对照组。检测各组血浆CD40配体、妊娠相关血浆蛋白A、丙二醛化低密度脂蛋白、低密度脂蛋白和高密度脂蛋白。结果Ⅱ型病变组血浆CD40配体、妊娠相关血浆蛋白A和丙二醛化低密度脂蛋白显著高于对照组、Ⅰ型病变组和Ⅲ型病变组(P均<0.01)。Ⅱ型病变组血浆CD40配体与妊娠相关血浆蛋白A呈正相关(r=0.446,P<0.01);丙二醛化低密度脂蛋白与低密度脂蛋白和高密度脂蛋白无明显相关性(P均>0.05),但与妊娠相关血浆蛋白A呈正相关(r=0.630,P<0.01)。结论冠状动脉造影显示斑块破裂的冠心病患者血浆CD40配体、妊娠相关血浆蛋白A和丙二醛化低密度脂蛋白水平明显升高;CD40配体与妊娠相关血浆蛋白A呈显著正相关,提示CD40配体可能通过上调妊娠相关血浆蛋白A的表达促进斑块破裂;丙二醛化低密度脂蛋白与妊娠相关血浆蛋白A呈正相关,提示氧化应激和炎症反应加强均是导致斑块破裂的原因,且氧化应激可能通过诱导、加剧炎症反应或与炎症因子交互作用发挥其致斑块破裂作用。Aim To evaluate the role of CD40 ligands （CD40L）, pregnancy-associated plasma protein A （PAPP-A）and malondialdehyde-modified low density lipoprotein （MDA-LDL） in the development of plaque disruption. Methods Eighty-five patients with coronary heart disease （CHD） and twenty-five controls were conected in this study. An patients underwent coronary angiography. The angiographic morphology of plaques was analyzed. According to the morphologic types of plaque, the patients with CHD were divided into type Ⅰ （smooth borders） group （n= 31） and type Ⅱ （irregular lesions） group （n=35） andtype Ⅲ （long lesions） group （n=19）. Plasma CD40L, PAPP-A and MDA-LDL were measured in all patients. Results Plasma CD40L, PAPP-A and MDA-LDL in type Ⅱ group were significantly higer than those in the control group, type Ⅰ group andtype Ⅲ group （P〈0.01）. The plasma levels of CD40L and PAPP-A had a significant positive correlation in the patients with type Ⅱ CHD（r=0.446, P〈0.01）. The plasma levels of MDA-LDL didn＇t correlate to low density lipoprorein （LDL） and high density lipoprotein （HDL） in the patients with type Ⅱ CHD （ P 〉 0.05）. The plasma levels of MDA-LDL and PAPP-A had a significant positive correlation in the patients with type Ⅱ CHD （ r = 0.630, P 〈 0.01 ）. Plasma levels of CD40L, PAPP-A and MDA-LDL increased in patients with coronary plaque rupture, CD40L and PAPP-A had a positive correlation, which indicated CD40L possibly facilitates the plaque rupture via upregulating the PAPP-A expression; MDA- LDL and PAPP-A had a positive correlation, which indicated the oxidative stress is likely to either induce or intensify inflammatory action, and may be co-effect with inflammation facts to cause or accelerate plaque rapture.

关 键 词：冠心病 CD40配体 妊娠相关血浆蛋白A 丙二醛化低密度脂蛋白 氧化应激 

分 类 号：R541.4[医药卫生—心血管疾病]