Th1/Th2平衡、分化簇抗原28、可诱导共刺激分子、程序性死亡受体-1和细胞毒性T淋巴细胞相关抗原-4在急性冠脉综合征患者外周血中的表达  

Expression of Th1/Th2 balance,differentiation cluster antigen 28,inducible costimulatory molecules,programmed death receptor-1 and cytotoxic T-lymphocyte associated antigen-4 in peripheral blood of patients with acute coronary syndrome

作　　者：许云耀 陈友莲 吴方辉 许云俊 XU Yunyao;CHEN Youlian;WU Fanghui;XU Yunjun(Department of Cardiology,Yuedong Hospital,the Third Affiliated Hospital of Sun Yat-sen University,Guangdong Province,Meizhou 514700,China)

机构地区：[1]中山大学附属第三医院粤东医院心内科,广东梅州514700

出　　处：《中国当代医药》2023年第30期64-69,共6页China Modern Medicine

基　　金：广东省医学科研基金立项项目(A2021501)。

摘　　要：目的研究Th1/Th2及相关细胞因子、共信号分子分化簇抗原28(CD28)、可诱导共刺激分子(ICOS)、程序性死亡受体1(PD-1)和细胞毒性T淋巴细胞相关抗原-4(CTLA-4)在急性冠脉综合征(ACS)患者外周血中的表达,并探讨其是否参与ACS的发病机制。方法前瞻性选取2021年7月至2022年4月经中山大学附属第三医院粤东医院心血管内科诊断为ACS的120例患者作为研究对象,采用ACS不同亚型的诊断标准将其分为不稳定型心绞痛(UA)组、ST段抬高型心肌梗死(STEMI)组、非ST段抬高型心肌梗死(NSTEMI)组,每组各40例。选取同时间段行冠状动脉造影检查正常的40例住院患者作为对照组。采用酶联免疫吸附(ELISA)法测定血清中的干扰素(IFN)-γ、白介素(IL)-2、IL-4和IL-10表达水平,采用流式细胞仪检测外周血互助性T细胞(Th)1、Th2细胞占CD4^(+)T细胞的比例以及共信号分子CD28、ICOS、PD-1、CTLA-4在CD4^(+)T细胞表面的表达水平,通过冠脉造影手术采用SYNTAX评分法评估ACS患者冠脉病变严重程度,比较四组上述各指标之间的差异并进行各指标之间的相关性分析。结果ACS患者外周血中Th1/Th2比值、Th1数量及相关细胞因子IFN-γ和IL-2的血清表达量高于对照组,其外周血CD3^(+)CD4^(+)T细胞的CD28、ICOS和PD-1表达量也高于对照组,差异有统计学意义(P<0.05);另外,STEMI组和NSTEMI组的这些指标也均高于UA组,差异有统计学意义(P<0.05);SYNTAX评分与外周血Th1数量、Th1/Th2比值、血清IFN-γ及IL-2水平和外周血CD3^(+)CD4^(+)T细胞的CD28及ICOS表达量呈明显正相关(P<0.05);外周血CD3^(+)CD4^(+)T细胞的CD28及ICOS表达量均与Th1数量、Th1/Th2比值、血清IFN-γ及IL-2表达水平呈明显正相关(P<0.05)。结论ACS患者外周血中的Th1、相关细胞因子IFN-γ和IL-2以及其CD3^(+)CD4^(+)T细胞的CD28、ICOS和PD-1表达较健康体检者均明显上调,其均可能在ACS的发病机制中发挥了重要作用。Objective To study the expression of Th1/Th2 and related cytokines and co-signaling molecules cluster of differentiation 28(CD28),inducible costimulator(ICOS),programmed cell death protein-1(PD-1),cytotoxic T lymphocyte-associated antigen-4(CTLA-4)in peripheral blood of patients with acute coronary syndrome(ACS),and to explore whether they are involved in the pathogenesis of ACS mechanism.Methods A total of 120 patients diagnosed as ACS in the Department of Cardiovascular of Yuedong Hospital,the Third Affiliated Hospital of Sun Yat-sen University from July 2021 to April 2022 were prospectively selected as the study objects.The patients were divided into the unstable angina pectoris(UA)group,the ST-elevation myocardial infarction(STEMI)group and the non-ST-elevation myocardial infarction(NSTEMI)group,with 40 cases in each group.A total of 40 hospitalized patients with normal coronary angiography at the same time were selected as the control group.The expression levels of interferon(IFN)-γ,interleukin(IL)-2,IL-4 and IL-10 in serum were determined by enzyme-linked immunosorbent assay(ELISA).Flow cytometry was used to detect the proportion of peripheral blood helper T cells(Th)1 and Th2 cells in CD4^(+)T cells and the expression levels of co-signaling molecules CD28,ICOS,PD-1 and CTLA-4 on the surface of CD4^(+)T cells.After coronary angiography surgery,the SYNTAX score was used to evaluate the severity of coronary lesions in ACS patients,and the differences among the above indicators among the four groups were compared and the correlation analysis among the indicators was performed.Results The Th1/Th2 ratio,Th1 quantity and serum expression levels of related cytokines IFN-γand IL-2 in peripheral blood of ACS patients were higher than those of control group,and the expressions of CD28,ICOS and PD-1 in peripheral blood CD3^(+)CD4^(+)T cells were also higher than those of the control group,with statistical significances(P<0.05).In addition,these indexes in the STEMI and NSTEMI groups were higher than those in the UA

关 键 词：急性冠脉综合征 分化簇抗原28 可诱导共刺激分子 程序性死亡受体-1 细胞毒性T淋巴细胞相关抗原-4 

分 类 号：R285.5[医药卫生—中药学]