【摘要】 目的 探讨TLR2信号通路激活对急性冠脉综合征患者冠脉病变的影响。方法 选择2015年1~12月在临沂市沂水中心医院行冠状动脉造影确诊的180例急性冠状动脉综合征患者为研究组;对照组是因胸痛入院但经冠状动脉造影排除冠状动脉粥样硬化,并除外其他疾病的患者50例。用流式细胞仪检测单核细胞表面TLR2蛋白表达,ELISA法检测血清TNF-α、IL-6水平,免疫浊度法测定hs-CRP。冠状动脉造影评价:冠状动脉造影评分采用Gensini评分标准,并根据Gensini评分将患者分为低Gensini组(n=44)、中Gensini组(n=95)及高Gensini组(n=41)组,比较各组之间TLR2表达比例,TNF-α、IL-6及hsCRP水平。术后电话随访1个月、3个月、6个月不良心血管事件的发生情况。结果 急性冠脉综合征患者单核细胞TLR2表达比例,TNF-α、IL-6及hs-CRP水平均较对照组升高,差异有统计学意义(P<0.05)。多支病变组和两支病变组外周血单核细胞表面TLR2表达水平及TNF-α、IL-6和hs-CRP高于单支病变组,差异有统计学意义(P<0.05)。Gensini评分高者,单核细胞TLR2表达比例高[(90.33±12.46)%],TLR2水平与Gensini评分呈正相关(r=0.297,P=0.009),TNF-α、IL-6、hs-CRP与Gensini评分呈正相关(r=0.396,P=0.019;r=0.113,P=0.024;r=0.201,P=0.005)。高Gensini组比低Gensini组不良心血管事件比例高(10.52%比4.76%),差异有统计学意义(P<0.05)。结论 急性冠脉综合征患者单核细胞TLR2蛋白表达水平能预测冠脉病变严重性,TLR2信号通路激活对冠心病风险有预测价值。更多还原

【Abstract】 Objective To analyze the relationship between the level of Toll-like receptor 2 signaling and the clinical manifestations of ACS and the severity of angiographic lesion.Methods A total of 180 ACS patients were scheduled to undergo elective cardiac catheterization for suspected coronary artery disease according to clinical manifestations of coronary heart disease from January to December 2015.Another 50 patients who were excluded for ACS by coronary angiography were enrolled as non ACS control group.Gensini scores of coronary angiographic stenosis were calculated in all patients.All subjects were divided into 3 groups:high Gensini group(n=44),medium Gensini group(n=95) and low Gensini group(n=41).Expression of TLR2 was detected by flow cytometric analysis.Levels of serum TNF-α,IL-6 and hs-CRP were measured,compared and analyzed in all groups.The occurrence of major adverse cardiac events were observed at 1-month,3-month and 6-month later.Results TLR2,TNF-α,IL-6,hs-CRP levels of patients with ACS group were apparently higher than those in the control group(P<0.01).TLR2,TNF-α,IL-6,hs-CRP levels in muti-vessel ACS group were higher than those in single-vessel ACS group and double-vessel ACS group(P<0.05).TLR2,TNF-α,IL-6,hs-CRP in double-vessel ACS group were higher than that in single-vessel ACS group(P<0.05).The levels of TLR2 showed positive correlation to Gensini score(r=0.297,P=0.009).The levels of TNF-α,IL-6 and hs-CRP showed positive correlation to Gensini score(r=0.396,P=0.019,r=0.113,P=0.024,r=0.201,P=0.005).Composite primary endpoint events in low Gensini score group decreased as compared with high Gensini score group(4.76%vs 10.52%,P<0.05).Conclusion Increased Toll-like receptor 2 signaling level may be related with occurrence of acute coronary syndrome,and its detection possesses certain application value for early diagnosis and treatment of acute coronary syndrome.更多还原