血清可溶性CD40L在冠心病患者中的价值  

The Value of Serum Soluble CD40 Ligand in Patients with Coronary Heart Disease

作　　者：李翠芝[1] 彭朝权[1] 邹丽媛[1] 吴晓[1] 

机构地区：[1]中山大学附属第三医院心内科,广东省广州市510630

出　　处：《中国动脉硬化杂志》2009年第2期145-149,共5页Chinese Journal of Arteriosclerosis

摘　　要：目的观察sCD40L在不同类型冠心病患者血清中的水平变化,明确sCD40L能否作为易损斑块的血清标志物,同时探讨它和冠心病传统危险因素的关系及其诊断急性冠状动脉综合征的临床价值。方法研究对象分四组:急性心肌梗死组(34例)、不稳定型心绞痛组(31例)、稳定型心绞痛组(30例)和非冠心病组(40例)。采用双抗体夹心酶标免疫分析法测定标本中sCD40L水平。结果(1)sCD40L水平:急性心肌梗死组(8.02±4.03μg/L)和不稳定型心绞痛组(8.35±3.89μg/L)明显高于稳定型心绞痛组(4.86±2.23μg/L)和非冠心病组(4.35±1.83μg/L)(均P<0.01);稳定型心绞痛组略高于非冠心病组,不稳定型心绞痛组略高于急性心肌梗死组,但差异均无显著性(均P>0.05)。(2)四组中男性sCD40L水平均高于女性,但差异均无统计学意义(P>0.05)。吸烟、冠心病家族史、高血压病和糖尿病不影响各组sCD40L水平;sCD40L与年龄、体质指数和血压无相关性(P>0.05);在冠心病患者中,sCD40L与脂蛋白(a)呈正相关(r=0.567,P=0.001),与高密度脂蛋白胆固醇呈负相关(r=-0.365,P=0.0001)。(3)以血清sCD40L、脂蛋白(a)和肌酸激酶同工酶作为诊断指标判断急性冠状动脉综合征,ROC曲线分析结果显示以sCD40L诊断价值最大,曲线下面积达0.872(P<0.05),最佳临界值为4.58μg/L,对应的灵敏度、特异度和准确率分别为82.8%、61.9%和85.7%。结论血清sCD40L在判定冠状动脉粥样硬化斑块易损性方面具有一定临床价值。sCD40L可能是冠心病的独立危险因素,sCD40L对急性冠状动脉综合征诊断的灵敏度、特异度、准确率较高,是诊断急性冠状动脉综合征的较理想指标。Aim To investigate changes of the level of serum soluble CD40 ligand （SCD40L） in the patients with acute coronary syndrome （ACS） so as to know if SCD40L can be as a serum marker of plaque vulnerability, and explore the relationship of SCD40L with the traditional risk factors of coronary heart disease （ CHD ） and its clinical value in early diagnosis of ACS. Methods All the cases of CHD and non-CHD were divided into acute myocardial infarction （ AMI ） group （ n = 34 ）, unstable angina （ UA）group （ n = 31 ） , stable angina （ SA ） group （ n = 30 ） and non-coronary artery disease （ NCAD ） group （ n = 40 ） . In all these groups, the level of SCD40L was detected by the enzyme -linked immuneosorbent assay （ ELISA ）. Results （ 1 ） The levels of sCD40L were higher in AMI group （ 8.02 ± 4.03μg/L） and in UA （8.35 ±3.89 μg/L） than those of SA group （4.86 ±2.23 μg/L） and NCAD group （4.35 ±1.83 μg/L） （ all P 〈 0.01 ） ; the difference of sCD40L levels between SA group and NCAD group, and between UA group and AMI group, were not significant （ all P 〉 0.05 ）. （ 2 ） The levels of sCD40L in men of four groups were higher than those of women, but the difference between men and women was no statisticly significant （ P 〉 0.05 ） ; The level of sCD40L was not correlated with body mass index, age, smoking status, hypertension, diabetes mellitus, family history of CHD （ P 〉 0.05 ） ; The level of sCD40L in patients with CHD was positively correlated with lipoproteina （ Lp（a） ） （ r = 0. 567, P = 0. 001 ） , negatively correlated with high density lipoprotein cholesterol （ HDLC ） （ r = - 0. 365, P = 0. 0001 ）. （ 3 ） In diagnosis of ACS, it was found that the area under ROC curve of sCD40L was 0. 872, the sensitivity, specificity and validity were 82.8% , 61.9 % and 85.7% respectively, which was the highest among all indexes including sCD40L and LP （a） and creatine kinasc-MB（ CK-MB）. The best critical level of

关 键 词：冠心病 不稳定性斑块 炎症因子 CD40配体 危险因素 

分 类 号：R541[医药卫生—心血管疾病]