冠状动脉斑块形态与CD40配体及妊娠相关蛋白酶-A的关系Association between CD40 ligands pregnancy-associated plasma protein-A and angiographic morphology of coronary lesions in patients with coronary heart disease
李旭平,张志辉,周胜华,刘启明,胡信群,祁述善
摘要(Abstract)：
目的 检测经冠状动脉造影显示为Ⅱ型斑块的冠心病患者血浆中CD4 0配体 (CD4 0L)和妊娠相关蛋白酶 A(PAPP A)水平 ,从临床角度探讨斑块破裂的原因。方法 对 6 8例经冠状动脉造影证实的冠心病患者的冠状动脉斑块形态进行分型。根据斑块形态 ,患者分为 4组 :Ⅰ型病变组 (表面光滑 ,n =1 9) ,Ⅱ型病变组 (表面不规则 ,n =33) ,Ⅲ型病变组 (长段表面不规则 ,n =1 6 ) ,另 2 5例冠状动脉造影正常的患者为对照组。所有患者检测血浆CD4 0L、PAPP A、心肌肌酸激酶 (CK)及肌酸激酶同工酶 (CK MB)。结果 Ⅱ型病变组血浆CD4 0L水平 [(3 2 1± 2 0 8)mg/L]显著高于Ⅰ型病变组[(1 0 3± 0 98)mg/L ,P <0 0 1 ]、Ⅲ型病变组 [(1 2 3± 0 88)mg/L ,P <0 0 5 ]和对照组 [(1 0 1± 0 94 )mg/L ,P <0 0 1 ]。Ⅱ型病变组血浆PAPP A[(1 6 8± 7 2 )mU/L]显著高于Ⅰ型病变组 [(7 3± 4 1 )mU/L ,P <0 0 1 ]、Ⅲ型病变组 [(8 9± 4 9)mU/L ,P <0 0 5 ]和对照组 [(7 1± 4 4)mU/L ,P <0 0 1 ]。Ⅱ型病变组血浆CD4 0L与PAPP A呈显著正相关 (r =0 44 6 ,P <0 0 1 )。结论 冠状动脉造影显示斑块破裂的冠心病患者血浆CD4 0L、PAPP A水平明显升高 ,且CD4 0L与PAPP A呈正相关。提示CD4 0L可能通过上调PAPP A的
关键词(KeyWords)： 冠状血管造影术;冠状动脉疾病;抗原,CD40;配体;妊娠相关血浆蛋白A
基金项目(Foundation): 湖南省自然科学基金课题 (0 2JJY2 0 43 )
作者(Author): 李旭平,张志辉,周胜华,刘启明,胡信群,祁述善
参考文献(References)：
- 1LamanJD ,DesmetBJGL ,SchonevldA ,etal.CD40CD40Linteractionsinarteriosclerosis.ImmunolToday,1997,18:272277.
- 2SchonbeckU ,MachF ,SukhoraGK ,etal.RegulationofmatrixmetalloproteinaseexpressioninhumanvascularsmoothmusclecellsbyTlymphocytes.CircRes,1997,81:448454.
- 3BayesGenisA ,ConoverCA ,OvergaardMT ,etal.Pregnancy associatedplasmaproteinAasamarkerofacutecoronarysyndromes.NEnglMed,2001,345:10221029.
- 4LevinDC ,FallonJT .Significanceoftheangiographicmorphologyoflocalizedcoronarystenosis:histopathologiccorrelation.Circulation,1982,66:316341.
- 5MonroneS ,ParilakL ,KerenskyR .angiographicpatternsandthenaturalhistoryofthevulnerableplaque.ProgCardiovascDis,2002,72:341342.
- 6刘海波,高润霖,陈在嘉,等.不稳定型心绞痛患者冠状动脉造影形态学特点及其意义.中国循环杂志,1996,11:35.
- 7MachF ,SchonbeckIL ,DonnefoyJY ,etal.activationofmonocyte/macrophagefunctionsrelatedtoacuteatheromacomplicationbyligationofCD40.Circulation,1997,96:396399.
- 8SchonbeckU ,MachF ,SukhoraGK ,etal.RegulationofmatrixmetalloproteinaseexpressioninhumanvascularsmoothmusclecellsbyTlymphocytes.CircRes,1997,81:448454.
- 9彭道泉,赵水平,李江,等.急性冠状动脉综合征患者血浆SCD40L的变化及其与黏附分子的关系.中华心血管病杂志,2002,3:141144.
- 10SchonbeckU ,MachF ,SukhovaGK ,etal.Expressionofstromelysin3inatheroscleroticlesions:regulationviaCD40CD40Lligandsignalinginvitroandinvivo.JExpMed,1999,189:843853.
- 11HennV ,SlupskyJS ,GrafeM ,etal.CD40ligandonactivatedplateletstriggersaninflammatoryreactiononendothelialcells.Nature,1998,351:591594.
- 12MachF ,SchonbeckU ,FabunmiRP ,etal.TlymphecytesindnceendothelialcellmatrixmetalloprotainaseexpressionbyaCD40L dependentmechanism:implicationsfortubuleformation.AmJPathol,1999,154:229238.