急性冠状动脉综合征患者PCI术后血浆妊娠相关蛋白A和CD40L的变化及其临床意义  

Changes of plasma CD40L and PAPP-A in patients with acute coronary syndrome after the PCI operation

作　　者：李旭平[1] 周胜华[1] 唐建军[1] 刘启明[1] 方臻飞[1] 胡信群[1] 周涛[1] 沈向前[1] 祁述善[1] 

机构地区：[1]中南大学湘雅二医院心内科,长沙410011

出　　处：《中南大学学报（医学版）》2007年第6期1098-1101,共4页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(02JJY2043)~~

摘　　要：目的:探讨急性冠脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)手术后血浆CD40L和妊娠相关蛋白-A(PAPP-A)水平的变化,以及PAPP-A对术后6个月内心血管事件和再狭窄发生的预测价值。方法:检测43例ACS患者(不稳定型心绞痛25例,急性心肌梗死18例)和25例稳定型心绞痛患者PCI术后CD40L和PAPP-A水平。采用酶联免疫吸附法(ELISA)检测其血浆中CD40L和PAPP-A的水平。并随访患者术后6个月内主要心血管事件(心绞痛、心肌梗死及死亡)发生情况,分析它们之间的关系。36例病人术后6月复查了冠脉造影,分析其支架内再狭窄情况。结果:ACS组(包括不稳定型心绞痛和急性心肌梗死病人)术后血浆CD40L和PAPP-A水平比稳定型心绞痛组高。直线相关分析发现ACS组患者CD40L与PAPP-A之间呈显著正相关(r=0.64,P<0.01)。手术后6月内有心血管事件组术后PAPP-A较无心血管事件组高。手术后6月内有再狭窄的病人术后PAPP-A水平较无再狭窄的病人高,且PAPP-A水平与PCI术后冠状动脉后期内径丢失指数呈正相关。结论:急性冠脉综合征病人CD40L和PAPP-A水平较稳定型心绞痛高,两者有显著相关。CD40L水平升高与ACS的关系可能与其刺激PAPP-A的表达增加有关。急性冠脉综合征病人PCI术后的PAPP-A水平的检测可以预测术后6月内主要心脏事件和再狭窄的发生。Objective To observe the changes and significance of plasma CD40L and pregnancy-associated plasma protein-A（PAPP-A）in acute coronary syndrome（ACS）patients after percutaneous coronary intervention（PCI）operation.Methods According to the occurrence of primary heart events or restenosis 6 months after the PCI,68 patients were divided into the ACS group and the stable anginapectoris（SAP）group.Plasma CD40L and PAPP-A after the PCI operation were measured and compared.Thirty-six patients underwent repeated angiography after the PCI.Their baseline and follow up angiograms were compared by quantitative coronary angiography to assess the incidence of restenosis.Results CD40L and PAPP-A after the PCI operation were higher in the ACS group than that in the SAP group.The group having primary heart events within 6 months had higher level of PAPP-A after the PCI.The group having restenosis 6 months had higher level of PAPP-A after the PCI.The change of later loss index of coronary artery lumen diameter was correlated with PAPP-A level after the PCI.Conclusion CD40L and PAPP-A were higher in the ACS group,indicating the possible mechanism by which CD40L facilitates the plaque rupture via up-regulating the PAPP-A expression.Plasma PAPP-A level after the PCI possibly forcasts the occurrence of primary heart events or restenosis within 6 months.

关 键 词：妊娠相关蛋白A 经皮冠状动脉介入治疗 CD40L 再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]