【作者】 张月婷；

【导师】 董平栓；

【作者基本信息】 河南科技大学 ， 内科学， 2010， 硕士

【摘要】 目的; 1.对比血浆可溶性CD40配体(Soluble cluster of differentiation 40 ligand,sCD40L)水平在不稳定性心绞痛(unstable angina pectoris,UAP)、稳定性心绞痛(stable angina pectoris,SAP)和对照组之间的差异,探讨sCD40L在UAP发病机制中的作用。2.研究血浆sCD40L水平与UAP患者近期发生心源性猝死、非致命性心肌梗死以及因病情需要而急诊行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)等急性心血管事件及危险分层的相关性,探讨sCD40L对UAP患者近期预后的影响。方法:选择冠心病患者69例,均经冠状动脉造影证实至少一支冠状动脉血管狭窄≥50%。其中包括UAP患者49例、SAP患者20例,分别按照2007年中华医学会心血管病学分会/中华心血管病杂志编辑委员会《不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南》和《慢性稳定性心绞痛诊断与治疗指南》入选。选择同期健康体检者和因不典型胸痛住院鉴别诊断的非冠心病患者共20例作为对照组,均进行冠状动脉造影证实冠状动脉血管正常。应用酶联免疫吸附法(enzyme-linked immunosorbent assays,ELISA)检测各组患者入院时血浆sCD40L水平。所有UAP患者入院后即以GRACE危险评分予以危险分层,并对患者入院后30天内的急性心血管事件(包括心源性猝死、非致命性心肌梗死以及病情需要的急诊PCI)进行随访。结果: 1. UAP组患者入院时血浆sCD40L水平[(9.39±1.89)ng/ml]明显高于SAP组[(5.92±2.06)ng/ml]和对照组[(4.91±1.97)ng/ml],差异均有统计学意义(P<0.01)。SAP组血浆sCD40L水平略高于对照组,但差异无统计学意义(P>0.05)。2. UAP患者根据血浆sCD40L水平高低分为sCD40L增高组和sCD40L正常组。随访结果发现,sCD40L增高组入院后30天的急性心血管事件(包括心源性猝死、非致命性心肌梗死以及病情需要的急诊PCI)发生率显著高于sCD40L正常组,差异有统计学意义(51.7%比10%,P<0.05)。3. UAP患者中,GRACE危险评分高危组血浆sCD40L水平明显高于中危组和低危组,中危组亦高于低危组,差异均有统计学意义(P<0.01)。三组血浆sCD40L水平分别为(11.93±1.06)ng/ml、(9.15±0.96)ng/ml、(7.35±0.89)ng/ml。结论: 1. sCD40L作为促炎与促血栓形成因子,可能在UAP的发病机制中起重要的调节作用。2. sCD40L是影响UAP近期预后的重要因素。UAP患者血浆sCD40L水平与其危险分层相一致,提示sCD40L可作为UAP临床危险分层有价值的生化指标。更多还原

【Abstract】 Objectives: 1. Through contrasting the variance of sCD40L among unstable angina pectoris group, stable angina pectoris group and the control group, to explore the role of sCD40L in the pathogenesis of unstable angina pectoris.2. By studying the relevance of sCD40L to recent acute cardiovascular events (including sudden cardiac death, nonfatal myocardial infarction and emegency percutaneous coronary intervention that was necessary to illness)and risk stratification, to explore the effects of sCD40L on the short-term prognosis of patients with unstable angina pectoris.Methods: Sixty-nine patients with coronary heart disease (49 patients with unstable angina pectoris, 20 patients with stable angina pectoris respectively) were enrolled in this study , who were verified by coronarography that the stenosis was≥50% of the vessel diameter at least in one of the coronary arteries. 69 patients were selected according to the diagnosis and treatment guideline (2007) for unstable angina pectoris / non-ST segment elevation myocardial infarction and that for stable angina pectoris formulated by Chinese Society of Cardiology / EditorialBoard of Chinese Journal of Cardiology respectively. Meanwhile, 20 contemporaneous cases of no coronary heart disease verified by coronarography were chosed as the controls.The 20 cases were hospitalized for atypical chest pain or for physical health examination. The plasma levels of sCD40L in three groups were detected in the method of enzyme-linked immunosorbent assays. All patients with UAP were evaluated with GRACE risk score on admission and had been followed up for 30 days from hospitalization. Clinical endpoints were sudden cardiac death, nonfatal myocardial infarction or emegency percutaneous coronary intervention that was necessary to illness at 30-days follow-up.Results: 1. The plasma level of sCD40L in UAP group [(9.39±1.89)ng/ml] was significantly higher than that in SAP group [(5.92±2.06)ng/ml] and in the control group [(4.91±1.97)ng/ml] (P<0.01). The plasma level of sCD40L in SAP group was higher than that in the control group, but the difference had no statistical significance.2. 49 patients with unstable angina pectoris were devided into elevated sCD40L group and normal sCD40L group according to the plasma levels of sCD40L .The incidence of acute cardiovascular events in elevated sCD40L group (51.7%) was significantly higher than that in normal sCD40L group(10%), the difference had statistical significance (P<0.05).3. The plasma level of sCD40L in high-risk group was significantly higher than that in moderate-risk group and in low-risk group(P<0.01), in moderate-risk group was also significantly higher than in low-risk group . The plasma levels of sCD40L in three groups of risk stratification were (11.93±1.06)ng/ml, (9.15±0.96)ng/ml and (7.35±0.89)ng/ml respectively.Conclusions: 1. Served as proinflammatory and prothrombotic factor , sCD40L may have regulating effect on the pathogenesis of unstable angina pectoris.2. sCD40L have influence on the recent prognosis of unstable angina pectoris. The plasma level of sCD40L was correlated with risk stratification in patients with unstable angina pectoris. sCD40L can be served as valuable marker in risk stratification for unstable angina pectoris clinically.更多还原