经皮冠状动脉腔内成形术对冠心病患者外周血白细胞膜表面粘附分子表达的影响(摘要)

中国循环杂志 1999年第0期第14卷 摘要　冠心病介入治疗

作者：梁春　吴宗贵　黄佐　仲人前　张玲珍　李莉

单位：上海市，中国人民解放军第二军医大学附属长征医院　心内科(200003)　梁　春　吴宗贵　黄　佐； 实验科　仲人前　张玲珍　李　莉

　　目的：为探讨经皮冠状动脉腔内成形术(PTCA)后白细胞膜表面粘附分子表达的变化。

　　方法：以行常规冠状动脉造影的11例冠心病患者为对照组，用流式细胞仪直接免疫荧光法检测21例行单支冠状动脉选择性PTCA冠心病患者术前、后30分钟中性粒细胞和单核细胞膜表面CD11b、CD49d和CD54表达。

　　结果：PTCA组与对照组间白细胞分类计数无显著差异(P＞0.05);流式细胞仪检查示两组中性粒细胞、单核细胞与CD—FITC单抗结合率均在95.8%以上，相互间差异无显著性；PTCA后中性粒细胞和单核细胞膜表面CD11b及CD49d表达明显升高(平均荧光密度由194±25、668±98,212±38、1011±125;升至244±27、972±103和268±46、1 552±231。P＜0.01),而CD54表达无明显变化；对照组间细胞粘附分子表达无显著差异。

　　结论：PTCA可使冠心病患者循环血中性粒细胞和单核细胞激活，并上调粘附分子CD11b及CD49d的表达。PTCA后白细胞的激活可能触发一系列病理生理联级反应，释放某些炎症介质，促进血管平滑肌增殖导致再狭窄；而针对白细胞激活为靶点进行干预有可能改善PTCA的预后。

Effects of Percutaneous transluminal Coronary Angioplasty on Expression of Adhesive Molecule on peripheral Leukocyte Membrane in Patients with Coronary Heart Disease(Abstract)

　　department of Cardiology, Changzheng Hospital, Second Military Medical university, Shanghai (200003)

　　liang Chun, Wu Zonggui, Huang Zuo, et al.

　　objective: To investigate the expression of adhesive molecule on leukocyte membrane in patients with coronary heart disease(CHD) undergoing percutaneous transluminal coronary angioplasty (PTCA).

　　Methods: Eleven patients with CHD undergoing coronary angiography were selected as controls. Twenty-one patients undergoing selective single-vessel PTCA were studied. The adhesive molecules (CD11b, CD49d and CD54) on membranne of neutrophil and monocytes were examined by using direct immuno-fluorescent method in flow cytometer. The peripheral blood was drawn before and 30 minutes after the procedure, respectively.

　　Results: The classification and count of the leukocytes have no significant difference between two groups. The combination rate of neutrophil, monocytes with the monoclone antibody CD-FITC was more than95.8% in all groups and with no difference between them. The expression of CD11b and CD49d on membrane of neutrophil and monocytes increased significantly after pTCA (the mean fluorescent density increases from 194±25, 668±98 and 212±38,1 011±125 to 244±27, 972±103 and 268±46, 1 552±231, respectively, p＜0.01). In contrast, the expression of CD54 did not change significantly. the expression of adhesive molecules has no significant difference in control group.

　　Conclusion: PTCA can activate the peripheral neutrophil and monocytes in patients with CHD. It also upgraded the expression of adhesive molecules CD11b and CD49d. Activation of leukocytes after PTCA can trigger a serial cascade of pathophysiologic reaction, releasing some inflammation intermediates lead to restenosis. Therapeutic intervention targeting the activation of leukocytes may gives the possibility to improve the prognosis of PTCA patients.