冠状动脉支架内再狭窄与炎症标志物及组织因子的关系  

Relationship between in-stent restenosis and inflammatory markers and tissue factors in patients with coronary heart disease

作　　者：马伟涛 夏大胜[2] 夏伟[2] 王丽[2] 卢成志[2] 何强[2] MA Wei-tao;XIA Da-sheng;XIA Wei;WANG Li;LU Cheng-zhi;HE Qiang(The First Central Clinical College,Tianjin Medical University,Tianjin 300192,China;Department of Cardiology,Tianjin First Center Hospital)

机构地区：[1]天津医科大学一中心临床学院,300192 [2]天津市第一中心医院心内科

出　　处：《天津医药》2019年第6期646-650,共5页Tianjin Medical Journal

摘　　要：目的探讨冠心病患者支架内再狭窄(ISR)与磷酸化c-jun、血小板CD40配体(CD40L)、血浆组织因子(TF)及组织因子途径抑制物(TFPI)的关系。方法选择经皮冠状动脉介入治疗(PCI)的冠心病患者200例,PCI术后1年复查冠脉造影,根据冠脉造影有无ISR分为ISR组(27例)与对照组(173例)。采用酶联免疫吸附测定法(ELISA)测定2组患者外周血白细胞裂解液中磷酸化c-jun和血清TF、TFPI水平,采用流式细胞技术测定血小板CD40L荧光强度。多因素Logistic回归分析发生ISR的危险因素。结果ISR组磷酸化c-jun、血小板CD40L荧光强度、TF、TFPI及TF/TFPI水平均高于对照组(P<0.01)。相关分析提示ISR组磷酸化c-jun水平与血小板CD40L荧光强度、TF及TFPI水平均呈正相关(rs分别为0.766、0.496、0.540,均P<0.05)。血小板CD40L荧光强度与TF、TFPI水平均呈正相关(r 分别为0.652、0.702,均P<0.05)。多因素Logistic回归分析显示,高血小板CD40L荧光强度和TF/TFPI是发生ISR的危险因素(P<0.05)。结论炎症标志物磷酸化c-jun、CD40L及TF高表达可能促进冠心病患者PCI术后ISR的发生。Objective To investigate the relationship between in-stent restenosis (ISR) and phosphorylated c-jun (reflecting the levels of activator protein-1), CD40L on platelets, tissue factors (TF) and tissue factor pathway inhibitor (TFPI) in patients with coronary heart disease. Methods A total of 200 patients undergoing percutaneous coronary intervention (PCI) were recruited in this study. According to the coronary angiography of 1 year after PCI, the patients were divided into ISR group (n=27) and control group (n=173). The amount of phosphorylated c-jun in leukocyte lysate, TF and TFPI were measured by enzyme-linked immunosorbent assay (ELISA), while the mean fluorescence intensity about CD40L on platelets was detected by flow cytometry. Risk factors for ISR were analyzed by multivariate Logistic regression. Results The absorbance of phosphorylated c-jun, the mean fluorescence intensity about CD40L on platelets, the plasma TF, TFPI and TF/ TFPI were significantly higher in the ISR group than those in the control group (P<0 .01). Correlation analysis showed that the absorbance of phosphorylated c-jun was positively correlated with the mean fluorescence intensity about CD40L on platelets, TF and TFPI (rs=0.766, 0.496 and 0.540, P<0.05). The mean fluorescence intensity about CD40L on platelets was positively correlated with TF and TFPI (r=0.652, 0.702, P<0.05). Multivariate Logistic regression analysis indicated that the higher mean fluorescence intensity about CD40L on platelets, TF/TFPI were risk factors for ISR (P<0.05). Conclusion The high expression of inflammatory markers, phosphorylated c-jun, CD40L and increased expression of TF may promote the occurrence of ISR after PCI in patients with coronary heart disease.

关 键 词：冠状动脉再狭窄 血管成形术 经腔 经皮冠状动脉 支架内再狭窄 磷酸化c-jun CD40配体 组织因子 

分 类 号：R541.4[医药卫生—心血管疾病]