急性心肌梗死患者经皮冠状动脉介入术后CD40L和sCD40L的变化及意义

通过急性心肌梗死（AMI）患者急诊经皮冠状动脉介入治疗（PCI）术前及术后CD40L和sCD40L的水平变化,探讨CD40L和sCD40L对AMI患者预后的评估作用。选择明确诊断为急性心肌梗塞,且6 h内行急诊PCI治疗的住院患者80例,将上述AMI组又分为AMI存活组和AMI死亡组。取同阶段冠脉造影完全正常或冠脉最大狭窄〈50%的患者80例作为对照组。于PCI术前0.5 h、术后即刻、12h、24 h、48 h取静脉血,检测血小板CD40L和sCD40L。结果显示：AMI组CD40L和sCD40L水平在PCI术前及术后即刻、12 h、24 h、48 h均高于对照组（P〈0.05）。AMI组CD40L和sCD40L水平在术后即刻较术前有显著增高,差异有显著性（P〈0.05）。术后12 h、24 h、48 h逐渐回落,48 h与术前比较无显著性差异（P〉0.05）。对照组CD40L和sCD40L在术后各时间点平均无统计学差异（P〉0.05）。AMI存活组PCI手术各时间点CD40L、sCD40L水平均低于AMI死亡组（P〈0.05）。AMI死亡组术后24 h内明显高于术前（P〈0.05）。结果证明AMI患者PCI术后CD40L和sCD40L水平增高,CD40L和sCD40L是AMI患者PCI后早期免疫炎症反应及预后的重要标志。

Changes and Significance of CD40L and sCD40L of Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

To explore the the role of CD40L and sCD40L in prognosis assessment of acute myocardial infarction（AMI） patients with primary percutaneous coronary intervention through the percutaneous coronary intervention（PCI） surgery.Eighty inpatients with definite diagnosis of acute myocardial infarction and emergency PCI within six hours were selected and divided into an AMI survival group and an AMI death group.Meanwhile,80 patients in the same stage with perfectly normal coronary angiography or 50%-lower coronary stenosis were selected as a control group.The level of CD40L and sCD40L in venous blood 0.5 hours before PCI,as well as at the moments immediately after the PCI and 12 h,24 h,48h after the PCI was tested.The results show that the CD40L and sCD40L level in AMI groups with PCI were higher than those of the control group at all moments（P ＆lt; 0.05）.The immediate postoperative CD40L and sCD40L level in AMI group were remarkably higher than the preoperative data（P ＆lt;0.05）.These indexes gradually fell after the PCI and almost returned to the preoperative data in 48h（P ＆gt;0.05）.The CD40L and sCD40L in the control group has no significant difference at the moments after the operation（P ＆gt;0.05）.The CD40L of sCD40L levels of the AMI survival group after PCI surgery at all time points were lower than the AMI death group（P ＆lt; 0.05）.The CD40L of sCD40L levels of the AMI death group within 24h after the surgery were significantly higher than those before the operation（P ＆lt; 0.05）.It is concluded that the CD40L and sCD40L levels of AMI patients after PCI are increased and they can be regarded as important symbols of early immune and inflammatory response and prognosis of AMI patients after PCI.