ACS患者脂蛋白相关磷脂酶A_2及CD4^+干扰素-γ阳性细胞与TIMI血流的关系  

Correlation between lipoprotein-associated phospholipase A_2,CD4^+ IFN-γ^+ positive cells and coronary TIMI blood flow in patients with acute coronary syndrome

作　　者：高虹[1] 庞新利[1] 陈纪言[2] 董少红[1] 梁新剑[1] 吴美善[1] 

机构地区：[1]暨南大学第二临床医学院心内科,广东深圳518020 [2]广东省人民医院广东省医学科学院广东省心血管病研究所,广州510100

出　　处：《岭南心血管病杂志》2010年第5期364-367,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨急性冠状动脉综合征(acute coronary syndromes,ACS)患者脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,LP-PLA2)、CD4+干扰素γ+(interferon-γ,IFN-γ+)细胞表达与经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流的关系。方法选择接受PCI治疗的ACS患者993例为研究对象。所有患者经冠状动脉造影确诊及行PCI治疗,根据TIMI血流0～Ⅲ级分为A、B、C、D共4个亚组;同期选择非冠状动脉粥样硬化性心脏病(冠心病)体检者580名为对照组。患者发病后24h内采用流式细胞仪检测CD4+IFN-γ+双阳性细胞比例,酶联免疫吸附法检测血清Lp-PLA2浓度。多元回归法分析TIMI血流与血清Lp-PLA2浓度、CD4+IFN-γ+双阳性细胞的比例的关系。结果 ACS患者起病24h内的血清Lp-PLA2浓度、CD4+IFN-γ+比例显著高于对照组比较,差异有统计学意义[(328.2±8.2)μg/L vs.(100.6±11.3)μg/L,P<0.05;32.6%±5.8%vs.8.8%±3.2%,P<0.05]。方差分析显示,A、B、C、D4个亚组PCI治疗后血清Lp-PLA2浓度、CD4+IFN-γ+双阳性细胞的比例比较,差异有统计学意义(P<0.05),且A、B组高于C、D组,差异有统计学意义(P<0.05)。多元回归分析显示,TIMI血流与血清Lp-PLA2浓度、CD4+IFN-γ+双阳性细胞的比例呈正相关(r=-0.693,P<0.05;r=-0.584,P<0.05)。结论检测血清Lp-PLA2浓度、CD4+IFN-γ+细胞比例对斑块的不稳定性评价及预测PCI治疗中的无再流或慢血流现象有重要意义。Objectives To observe the correlation between lipoprotein-associated phospholipase A2（LP-PLA2）,CD4^＋ interferon （IFN）-γ^＋ positive cells and coronary thrombolysis in myocardial infarction （TIMI） blood flow in patients with acute coronary syndromes （ACS）. Methods We selected 993 patients with ACS as objects （ACS group）and 580 persons examinated without coronary disease as controls （control group）. All the patients were conducted percutaneous coronary interventions （PCI） and divided into A, B, C, D groups by TIMI blood flow. Peripharal blood samples were collected within 24 h. CD4＋ IFN-y^＋ positive cell levels were detected with flow cytometry （FCM）, serum concentration of Lp-PLA2 was detected by enzyme-linked immunosorbent assay （ELISA）. Results Serum concentration of Lp-PLA2 and CD4^＋IFN-γ^＋ positive cells levels of ACS group were significantly higher than those in control group [ （328.2±8.2） μg/L vs. （100.6±11.3）μg/L,P〈0.05;32.6%±5.8% vs.8.8%±3.2% ,P〈0.05]. Analysis of variance indicated that serum concentration of Lp-PLA2 and CD4^＋ IFN-γ^＋ positive cell levels of A, B, C, D group were significantly difference （P〈0.05）. Moreover, serum concentration of Lp-PLA2 and CD4^＋ IFN-γ^＋ positive cell levels of A, B group were significantly higher than those in C, D group （P〈0.05）. Multiple regression analysis indicated that TIMI blood flow was positive correlated with serum concentration of Lp-PLA2 and CD4^＋ IFN-γ^＋ positive cell levels （r=-0.693 ,P〈0.05 ;r=-0.584,P〈0.05）. Conclusions Serum concentration of Lp-PLA2 and CD4^＋ IFN-γ^＋ positive cell level may be good predictive factors for unstable plaque of ACS, and could be used to prognosticate of slow-flow or non-flow after PCI.

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 干扰素Γ 脂蛋白相关磷脂酶A2 

分 类 号：R541.4[医药卫生—心血管疾病]