The Expression Of CD40 Ligand In Coronary And Peripheral Blood And Its Clinical Significance In Patients With Coronary Artery Disease

Buckgroud and objectiveMany researches support the atherosclerosis is a choronic inflammatory process and implicate componets of the immune system inatherogenesis.Disruption of vulnerable atheromatous plaque is the most common pathophysilogic change in acute coronary syndromes.Recent research has documented CD40L-CD40 interactions as a important inflammatory infactor ,which mediate responses that could serve to accelerate the athero-sclerotic process and trigger plaque rupture. Some experiments showed that CD40L—CD40 could be expressed in macrophages, lymphocytes, endothelial cells, andvascular smooth muscle cells. However, little information exists concerning the coexpression of CIMO and CIMOL on human monoeytes and in human atherosclerotic lesions.In our present study, Blood samples were taken from coronary and femoral artery, and the concentration of sCD40L, expression of CD40L on monoeytes and lymphocyte was mearsured, to investigate the relationship between atherosclerosic plaque and local inflammation, relationship of the stablity of atherosclerosicplaque and local inflammation. Date and Mathod 一, Study subjectsCoronary heart disease (CHD) group consisted of 38 patients with acute coronary syndrome(ACS) and stable angina(SAP), who were admitted to our cardiac department. Of whom, 20 patients fulfilling the criteria for ACS were selected,include 15 males and 5 females,mean age 61.72 yrs. Include criteria: angiographically proven acute myocardial infarction or unstable angina (stenosis of ≥50% in at least one of the left desending branch,left circumflex branch,and right coronary artery ). 18 patients with SAP were selected, 12 males and 6 females,mean age 60.13yrs,which were also proven by coronary angiography.20 patients (12 male and 8 female) wre selected for controlgroup, with coronary angiography found no stenosis. 二, Mathod1, Common clinic data: inquire the past medical history of all candidates, such as hypertention, diabetes mellitus, hyperlipemia, smoking,measure stature, body weight and some biochemical lab data.2, Blood sampling protocol: the blood samples were taken during angiography from each patient .we used two blood samples, one taken from the coronary artery catheter,and the other taken from femoral artery. Both samples have 5 ml,in which 2ml for measuring sCD40L after coagulated for 45 minuts spontaneously , centrifugal 1500r/min for 5mins, stored at -70℃,. And the left 3 ml sample was used to measure surface expression of CD40L on lymphocyte and monocyte by flow cytometry.3, The plasma levels of Soluble CD40L(sCD40L) was determined with ELISA according to the manufacturers instructions.4, surface expression of CD40L on lymphocyte and monocyte was measured with CD40L—PE and IgG₁—PE fluo-monoclonal antibody,all flow cytometic analyses were performed on an EPICS— X_L instrument.5 , Biochemical index was measured in clinical laboratory of our hospital.三, Statistical analysisAll calculations wre performed using SPSS12.0 statistical software.camparions between two tails were made by t test,among three tails made by analysis of variance.The gender-proportion and proportion of smoking were made by x² tset. The association between CD40L and serum lipid made by Correlation Analysis.A value of p < 0.05 was considered significant. Result1,The cardiovascular risk factors did not differ among the ACS, SAP, and C group (P>0.05).2, The concentration of sCD40L, expression percentage of CD40L on lymphocyte and monocyte from coronary artery of ACS group is 5.34±1.45 μg, 28.34±11.73%, 39.31±8.79%,which was significant higher compared with SAP and C group (p<0.05) .There were no significant differences between SAP group and C group (p>0.05) .3, The concentration of sCD40L, expression percentage of CD40L on lymphocyte and monocyte from peripheral artery of ACS group is 3.87± 1.25 μg, 27.57±11.12%, 39.17± 9.83%,which was significant higher compared with SAP and C group(p<0.05). There were no significant differences between SAP group and C group (p>0.05) .4, Patients with ACS had significant higher concentration of sCD40L in coronary artery than in peripheral artery.( 5.34± 1.45 μ g vs 3.87 ±1.25 μg) (p<0.05) .while there were no significant differences in SAP group and C group (p>0.05) .5, No significant differences in expression of CD40L were detected among the three group, both in coronary artery and in peripheral artery. (p > 0.05 ).6, The concentration of sCD40L and CD40L expression on lymphocyte and monocyte showed no association with the level of serum lipid.7, After analysis of variance,we got the F value of serum lipid level (TG,TC,HDL-C, LDL-C) and the concentration of sCD40L , CD40L expression on lymphocyte and monocyte,there was no significant difference in serum lipid level between ACS group and SAP group,also between ACS group and control group, the F value were 0.341 (p>0.05) ,0.259 (p>0.05) ,0.477 (p>0.05) ,2.666 ( p > 0.05 ) .while there was significant difference in the concentration of sCD40L and CD40L expression on lymphocyte and monocyte, the F value were 163.960 (p<0.05) ,80.920 (p< 0.05) ,199.520 (p<0.05) . Conclusion1, The patients with ACS had significant higher concentration of sCD40L in coronary artery than in peripherical artery,while no significant difference were shown in patients with stable angina, .the results suggest that stable plaque had no direct relation with inflammation,while unstable plaque associate with local inflammation ,rather than systemic inflammation.2, The patients with ACS had higher concentration of sCD40L in peripherical artery , also characterized by enhanced expression of membrance-bound CD40L on both lymphocyte and monocyte , compared with both controls and patients with stable angina,while no significant difference were shown in patients with stable angina. The phenomenon suggests that the expression CD40L in peripherical vessels had association with the stability of plaque ,we could detect the stability of plaque by the way of measuring the CD40L in peripherical vessels.3, The concentration of sCD40L, expression of membrance-bound CD40L on both lymphocyte and monocyte had no association with the level of serum lipid .