趋化因子CCL21及其受体CCR7与冠状动脉易损斑块的相关性研究  

The correlation between chemokine CCL21,its receptor CCR7 and coronary vulnerable

作　　者：金鑫[1] 韩朝鑫[1] 王彦富[1] 张慧玲[1] 孙景芝[1] 张宗雷 李清贤[1] 

机构地区：[1]山东省心脏疾病诊疗重点实验室济宁医学院附属医院,山东济宁2720292 [2]济宁医学院

出　　处：《临床心血管病杂志》2015年第12期1293-1299,共7页Journal of Clinical Cardiology

摘　　要：目的:探讨趋化因子CCL21及其受体CCR7与冠状动脉(冠脉)易损斑块之间的关系。方法:选择行冠脉造影(CAG)患者180例,其中急性冠脉综合征(ACS)患者60例(ACS组),稳定型心绞痛(SAP)患者60例(SAP组),CAG正常且没有其他粥样硬化证据患者60例(对照组)。ACS组和SAP组患者在CAG后行血管内超声(IVUS)检查。采用双抗体夹心酶联免疫吸附法(ELISA法)检测血清趋化因子CCL21及高敏C反应蛋白(hs-CRP)的浓度,用流式细胞术测定外周淋巴细胞表面CCR7的表达水平。结果:血清趋化因子CCL21浓度与外周淋巴细胞CCR7的表达在备组之间有显著差异(均P<0.05);应用CCL21判断ACS的ROC曲线下面积,大于应用hs-CRP判断ACS的ROC曲线下面积[(0.803±0.027):(0.71 6±0.021),P<0.01]。IVUS发现ACS组主要为脂质性斑块(65%),而SAP组主要为纤维性斑块(57%),脂质斑块仅占13%,两组差异有统计学意义(P<0.01);ACS组斑块负荷和血管重构指数明显大于SAP组(P<0.01);利用IVUS测定的斑块负荷与趋化因子CCL21浓度呈显著正相关(r=0.795,P<0.01),与外周淋巴细胞表面CCR7的表达呈显著负相关(r=-0.693,P<0.01)。结论:趋化因子CCL21及其受体CCR7与冠脉斑块易损性密切相关,较hs-CRP具有更高的早期诊断和判断预后的价值。Objective：To investigate the relationship between the chemotactic factor CCL21 and its receptor CCR7 and coronary vulnerable plaque.Method：A total of 180 patients underwent coronary angiography（CAG）was included into three groups：acute coronary syndrome（ACS） group（n = 60）,stable angina pectoris（SAP）group（n=60） and control group（patients with normal coronary angiography and without other evidence of atherosclerosis,n=60）.ACS group and SAP group underwent intravascular ultrasound（IVUS） examination after CAG.Double antibody sandwich enzyme linked immunosorbent assay（ELISA method） was used to detect the serum levels of chemokine CCL21 and hs-CRP,flow cytometry was used to determin the expression of peripheral CCR7.Result：Serum levels of chemokine CCL21 concentration and expression of peripheral lymphocyte CCR7 had significant difference in three groups（all P〈0.05）.The area under the ROC curve of CCL21 was greater than that of hs-CRP[（0.803 ± 0.027）;（0.716 ± 0.021）,P〈0.01].IVUS results showed that ACS group mainly had lipid plaque（65%）,and SAP group mainly had fibrous plaque（57%）accompanied by onlyl3%lipid plaque（P〈0.01）.The plaque load and vascular remodeling index in ACS group were significantly higher than those in SAP group（both P〈0.01）.The plaque load was significantly positively correlated with chemokine CCL21 concentration（r=0.795,P〈0.01）,and significantly negatively correlated with the expression of peripheral lymphocyte surface CCR7（r=-0.693,P〈0.01）.Conclusion：Chemokine CCL21 and its receptor CCR7 are closely related to coronary plaque vulnerability,and have more early diagnosis and prognosis values than hs-CRP.

关 键 词：冠心病 趋化因子 易损斑块 血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病]