冠心病不同分型患者巨噬细胞凋亡和M1/M2极化水平变化的研究  

Study on the macrophage apoptosis and M1/M2 polarization in patients with different types ofcoronary heart disease

作　　者：龚兆会[1] 赵新军[1] 罗川晋[1] 褚庆民[1] 吴伟[1] 李荣[1] GONG Zhaohui;ZHAO Xinjun;LUO Chuanjin;CHU Qingmin;WU Wei;LI Rong(Department of Cardiology,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院心血管科,510405

出　　处：《天津医药》2022年第5期503-508,共6页Tianjin Medical Journal

基　　金：广东省医学科学技术研究基金项目(A2019507);广州市科技计划项目(202102020927)。

摘　　要：目的观察冠脉正常者和冠心病不同分型患者外周血巨噬细胞凋亡率和巨噬细胞M1/M2极化水平并探讨其意义。方法纳入稳定型心绞痛(SA)组、不稳定型心绞痛(UA)组、急性心肌梗死(AMI)组及冠脉正常者(对照组)各40例。收集所有研究对象的临床资料,包括性别、年龄、身高、体质量、体质量指数(BMI),入组后48 h内丙氨酸转氨酶(ALT)、血肌酐(Scr)、肌酸激酶同工酶(CK-MB)、超敏肌钙蛋白I(hs-TnI)和出院前的心脏彩超射血分数(EF)值。入组后48 h内取患者外周血,分离并培养获得巨噬细胞,检测巨噬细胞凋亡率,M1、M2型巨噬细胞比例及其比值,分析其与冠心病各分型的关系。Logistic回归分析巨噬细胞凋亡率和M1/M2比值对冠心病及UA的影响;采用受试者工作特征(ROC)曲线分析巨噬细胞凋亡率、M1/M2比值及两者联合应用对冠心病及UA的诊断价值。结果4组性别、年龄、身高、体质量、BMI、ALT、Scr比较差异均无统计学意义。AMI组较对照组、SA组和UA组hs-TnI和CK-MB升高,EF降低(P<0.01);对照组、SA组、UA组间hs-TnI、CK-MB差异均无统计学意义。UA组和SA组EF比较差异无统计学意义,但均较对照组降低(P<0.01)。对照组、SA组、UA组和AMI组巨噬细胞凋亡率、M1型巨噬细胞比例和M1/M2比值逐次升高(P<0.01)。Logistic回归结果显示巨噬细胞M1/M2比值和巨噬细胞凋亡率升高为冠心病和UA的危险因素。ROC分析显示,巨噬细胞M1/M2比值和凋亡率对冠心病均有一定诊断价值,联合应用诊断价值更高(AUC分别为0.835、0.898、0.926);M1/M2比值和凋亡率对UA均有一定诊断价值,联合应用诊断价值更高(AUC分别为0.807、0.796、0.862)。结论巨噬细胞凋亡率和M1/M2比值与冠心病和UA密切相关,且有一定的预测价值。Objective To observe the apoptosis rate of peripheral blood macrophages and the polarization level of macrophages M1/M2 in patients with normal coronary artery and patients with different types of coronary heart disease,and explore their significance.Methods Patients with stable angina(SA group),patients with unstable angina(UA group),patients with acute myocardial infarction(AMI group)and subjects with normal coronary artery(control group)were included,40 cases for each group.General clinical data of all research subjects were collected,including gender,age,height,weight,body mass index(BMI),and alanine aminotransferase(ALT),serum creatinine(Scr),creatine kinase isoenzyme(CKMB),high-sensitivity troponin I(hs-TnI)within 48 hours after enrollment,and ejection fraction(EF)value from cardiac color Doppler ultrasound before discharge.Peripheral blood samples were collected from patients within 48 h after enrollment,and macrophages were isolated and cultured.Apoptosis rate of macrophages,proportion and ratio of M1 and M2 macrophages were detected,and the relationship between them and different types of coronary heart disease were analyzed.Logistic regression was used to analyze the effects of macrophage apoptosis rate and M1/M2 ratio on coronary heart disease and UA.Receiver operating characteristic(ROC)curve was used to analyze the apoptosis rate of macrophages,M1/M2 ratio and the predictive value of their combined application on coronary heart disease and UA.Results There were no significant differences in gender,age,height,body mass,BMI,ALT and Scr between the 4 groups.Compared with the control group,the SA group and the UA group,hs-TnI and CK-MB increased and EF decreased in the AMI group(P<0.01).There were no significant differences in hs-TnI and CK-MB between the control group,the SA group and the UA group.There was no significant difference in EF between the UA group and the SA group,but which was lower than that of the control group(P<0.01).The apoptosis rate of macrophages,the proportion of M1-type macrophage

关 键 词：冠心病 心绞痛 不稳定型 细胞凋亡 ROC曲线 巨噬细胞极化 

分 类 号：R541.4[医药卫生—心血管疾病]