CAJ | 학술논문

目的观察急性心肌梗死患者血清可溶性CD40配体(sCD40L)水平和血浆纤维蛋白原(Fg)的变化以及与临床预后的关系.方法采用酶联免疫吸附法测定60例急性心肌梗死患者血清sCD40L水平,用全自动血凝分析仪测定血浆Fg,患者出院后随访2年,观察心血管事件.结果急性心肌梗死患者sCD40L水平(15.36±7.32)μg/L显著高于正常对照组(5.79±2.78)μg/L(P<0.001).急性心肌梗死患者中Fg水平(4.60±1.37)g/L显著高于正常对照组(3.03±0.82)g/L(P<0.001).发生心血管事件患者的sCD40L(18.14±6.34)μg/L和Fg(4.97±1.33)g/L显著高于无心血管临床事件患者的sCD40L(14.38±6.67)μg/L和Fg(4.20±1.24)g/L(P<0.05).sCD40L水平≥14.5 μg/L或Fg≥4.4 g/L的患者的心血管事件发生增多(P<0.05).合并糖尿病的急性心肌梗死患者sCD40L水平(18.38±6.71) μg/L显著高于不合并糖尿病的急性心肌梗死患者(14.46±6.48)μg/L(P<0.05).相关性分析显示在AMI患者中sCD40L与Fg正相关(r=0.27,P<0.05),Fg与左室射血分数负相关(r=-0.319,P<0.05).结论急性心肌梗死患者血清sCD40L水平和Fg升高,sCD40L和Fg明显升高的患者发生心血管事件的风险明显升高,糖尿病是sCD40L升高的临床危险因素,sCD40L和Fg是急性心肌梗死患者的预后指标,在急性心肌梗死的病理生理过程中起重要作用.
목적 관찰급성심기경사환자혈청가용성CD40배체(sCD40L)수평화혈장섬유단백원(Fg)적변화이급여림상예후적관계.방법 채용매련면역흡부법측정60례급성심기경사환자혈청sCD40L수평,용전자동혈응분석의측정혈장Fg,환자출원후수방2년,관찰심혈관사건.결과 급성심기경사환자sCD40L수평(15.36±7.32)μg/L현저고우정상대조조(5.79±2.78)μg/L(P<0.001).급성심기경사환자중Fg수평(4.60±1.37)g/L현저고우정상대조조(3.03±0.82)g/L(P<0.001).발생심혈관사건환자적sCD40L(18.14±6.34)μg/L화Fg(4.97±1.33)g/L현저고우무심혈관림상사건환자적sCD40L(14.38±6.67)μg/L화Fg(4.20±1.24)g/L(P<0.05).sCD40L수평≥14.5 μg/L혹Fg≥4.4 g/L적환자적심혈관사건발생증다(P<0.05).합병당뇨병적급성심기경사환자sCD40L수평(18.38±6.71) μg/L현저고우불합병당뇨병적급성심기경사환자(14.46±6.48)μg/L(P<0.05).상관성분석현시재AMI환자중sCD40L여Fg정상관(r=0.27,P<0.05),Fg여좌실사혈분수부상관(r=-0.319,P<0.05).결론 급성심기경사환자혈청sCD40L수평화Fg승고,sCD40L화Fg명현승고적환자발생심혈관사건적풍험명현승고,당뇨병시sCD40L승고적림상위험인소,sCD40L화Fg시급성심기경사환자적예후지표,재급성심기경사적병리생리과정중기중요작용.
Objective To observe the changes of serum soluble CD40 ligand (sCD40L) and fibrinogen in acute myocardial infarction (AMI) patients and to investigate the clinical predictive value of increased serum sCD40L and fibrinogen. Methods Serum sCD40L level of 60 AMI patients was determined by enzyme-linked im-munosorbent assay (ELISA). Plasma level of fibrinogen was measured. The patients were followed up for 2 years af-ter discharge from the hospital and were observed for cardiovascular event. Results AMI patients had higher sCD40L and fibrinogen levels than those of controls [(15.36±7.32) μg/L vs. (5.79±2.78) μg/L, (4.60±1.37)g/L vs. (3.03±0.82) g/L,P<0.001] ,which were significantly higher in the patients experiencing cardio-vascular event than those without cardiovascular event [(18.14±6.34) μg/L vs. (14.38±6.67) μg/L and (4.97±1.33)g/L vs. (4.20±1.24} g/L] (P<0.05). The patients with sCD40L≥14.5 μg/L or fibrinogen≥ 4.4 g/L experienced increased risk of adverse cardiovascular events (P<0.05). In AMI patients, sCD40L level was significantly higher in patients with diabetes than in nondiabetics [(18.38±6.71) μg/L vs. (14.46±6.48) μg/L, P<0.05)]. Fibrinogen level was related to sCD40L (r=0.27, P<0.05) and LVEF(r=-0.319, P<0.05). Conclusion Increased sCD40L and fibrinogen levels,which maybe related to the pathogenesis of AMI,can be found in AMI patients and can indicate an independent increased risk of major adverse cardiovascular events. Diabetes is independently associated with elevated sCD40L level in AMI patients.