【摘要】 目的研究不同性质斑块冠心病患者外周循环中树突状细胞(DCs)数量和功能的变化,探讨DCs与冠脉粥样硬化斑块稳定性关系。方法入选病例总共40例,依据临床情况、冠状动脉造影分为稳定心绞痛(SAP)组(10例)、不稳定心绞痛(UAP)组(10例)、急性冠脉综合征(ACS)组(10例)和正常对照(CTL)组(10例)。血管内超声(IVUS)确定冠状动脉斑块性质,流式细胞4色分析法检测DCs及亚型的比例和数量;流式细胞仪及酶联免疫吸附实验检查DCs功能。结果IVUS确定SAP组患者8例为稳定斑块、2例不稳定斑块,UAP组不稳定斑块7例,稳定斑块2例,破裂斑块1例,而ACS组破裂斑块6例,不稳定斑块3例,稳定斑块1例。不稳定斑块组DCs、mDCs、mDC1s的占外周血白细胞比例及绝对数均比稳定斑块组显著增多;破裂斑块组患者的DCs、mDCs、mDC1s、pDCs比例及绝对数均显著减少。体外培养冠心病患者外周血单个核细胞(PBMC)源性DCs后,测定不同性质斑块冠心病中患者中DCs功能:培养第7天,不稳定斑块组DCCD83表达高于稳定斑块组,破裂斑块组显著高于不稳定斑块组,稳定斑块组和CTL组差异无显著意义。培养第7天,在DCs数量为2×105/ml时,不稳定斑块、破裂斑块组DCs刺激T细胞增殖的能力显著高于稳定斑块组,稳定斑块组和CTL组差异无统计学意义;混合淋巴细胞反应上清液中IL-12、IFN-α浓度:不稳定斑块组、破裂斑块组IFN-α、IL-12显著高于稳定斑块、CTL组,SAP、CTL组差异无显著意义。结论外周血DCs数量、比例及功能可以反应冠心病患者冠状动脉斑块稳定性变化。更多还原

【Abstract】 Objective To study the quantitative and functional changes of peripheral blood dendritic cells (DCs) and their subsets in the leukocyte population in patients with coronary artery disease (CHD) with different coronary artery plaques and explore the relation between DCs and coronary plaque development. Methods Thirty CHD patients were divided into SAP (10 cases), UAP (10 cases) and ACS (10 cases) groups, with another 10 patients having negative result in coronary angiography as the control group. Intravascular ultrasound (IVUS) was performed to identify the nature of the plaques. The percentage and absolute number of peripheral blood DCs and DC subsets were measured by flow cytometry. The functional status of the DCs was analyzed by enzyme-linked immunosorbent assay (ELISA) and flow cytometry. Results In the SAP group, IVUS found stable plaques in 8 cases and unstable plaques in 2 cases; in UAP group, 7 patients had unstable plaques, 2 had stable plaques, and 1 had plaque rupture. Plaque rupture, unstable plaques and stable plaques were found in 6, 3 and 1 patients in ACS group, respectively. In comparison with patients with stable plaques, those with unstable plaques had significantly increased percentages and number of DCs, mDCs and mDC1 (P<0.05), while the mDC2s and pDCs showed no obvious difference between them (P>0.05). The percentages and number of DCs, mDCs, mDC1s and pDCs were significantly decreased in patients with ruptured plaques (P<0.05). In peripheral blood monouclear cells cultured for 7 days, the CD83 expression was significantly higher in unstable and rupture plaque groups than in stable plaque group, and no significant difference was found between stable plaque group and the control group (P>0.05). In unstable and rupture plaque groups, co-culture with 2×105/ml DCs evoked strong proliferation of the T cells in comparison with the stable plaque group, but no difference was found between the stable plaque and the control groups (P>0.05). Significantly higher levels of interleukin-2 and interferon-α were detected in the supernatant of the mixed lymphocyte reaction in unstable and ruptured plaque groups than in stable plaque and control groups, without obvious difference between the latter two groups. Conclusion The percentage and absolute number of peripheral blood DCs and their functional status suggest the alterations of the coronary artery plaques in CHD patients.更多还原