血清可溶性CD40配体对急性冠状动脉综合征的诊断

目的观察可溶性CD40配体(sCD40L)在急性冠状动脉综合征(ACS)、稳定型心绞痛及非冠心病患者血清中的变化,探讨其用于判断急性冠状动脉综合征的临床应用价值。方法选取我科2002年4月至2003年12月住院患者及部分随访患者共156例,其中急性冠状动脉综合征患者77例(包括急性心肌梗死患者37例,不稳定型心绞痛患者40例),稳定型心绞痛患者42例,非冠心病对照患者37例。应用ELISA法测定各组患者血清sCD40L水平并进行比较,ROC曲线分析sCD40L诊断急性冠状动脉综合征的临床价值。结果①急性冠状动脉综合征组患者血清sCD40L水平显著高于稳定型心绞痛患者和非冠心病患者(P<0.05),而急性冠状动脉综合征患者中急性心肌梗死和不稳定心绞痛患者之间没有显著性差异(P>0.05),稳定型心绞痛患者和非冠心病对照患者之间也没有显著性差异(P>0.05);②用sCD40L诊断急性冠状动脉综合征其ROC曲线下面积为0.773,灵敏度、特异度、准确率分别为82.8%、61.9%、85.7%。结论血清sCD40L水平升高代表着斑块的不稳定状态,对急性冠状动脉综合征的诊断有一定应用价值。

The role of serum soluble CD40 ligand in diagnosis of acute coronary syndrome

Objective To observe the changes of serum soluble segment of CD40 ligand(sCD40L)in patients with acute coronary syndrome(ACS),stable angina pectoris(SAP) and patients without coronary heart disease,and then evaluate the value of sCD40L in diagnosis of ACS.Methods Contents of sCD40L in serum were measured by chemiluminescent enzyme-linked immunosorbent assay from 77 patients with ACS(including 37 acute myocardial infarction and 40 unstable angina pectoris),42 patients with stable angina pectoris and 37 non-CHD patients who were all enrolled in our department during Apr.2002 to Dec.2003 or revisited during that period.And then serum sCD40L levels of each group was constrasted,and ROC curve was used to analyze the diagnostic value of sCD40L,TC,LDL and CK-MB in ACS.Results ①The ACS group had a higher serum sCD40L levels than SAP and non-CHD group(P<0.05);there was no significant difference between AMI and UAP patients(P>0.05),and neither between SAP and non-CHD patients(P>0.05).② On diagnosing ACS,the area under ROC curve of sCD40L was 0.773,the sensitivity,specificity and validity are 82.8%,61.9% and 85.7%,respectively,which were all highest among so much indexes.Conclusion High serum sCD40L levels may suggest vulnerable plaque,and it's somewhat valuable in diagnosing ACS.