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目的探讨不稳定型心绞痛(unstable angina,UA)患者外周血血小板微粒(platelet microparticle,PMP)及其表面功能蛋白CD62p、PAC-1、CD42b和CD40L表达水平与UA严重程度的关系。方法110例UA患者为UA组,按Braunwald分级分为Ⅰ级(35例)、Ⅱ级(37例)和Ⅲ级(38例)3个亚组;选择同期体检健康者30例为对照组。应用流式细胞仪检测PMP及其表面膜功能蛋白CD62p、PAC-1、CD42b、CD40L表达水平,并分析上述指标与UA严重程度的关系。结果 UA组外周血PMP[220.35(128.39,374.76)个/μL]及其表面CD62p[37.22(30.29,46.62)%]、PAC-1[19.30(2.27,8.42)%]、CD40L[(15.61(7.37,24.02)%]表达水平明显高于对照组[78.21(29.00,115.18)个/μL、24.06(16.00,26.79)%、0.82(0.88,5.89)%、3.75(1.06,8.05)%](P<0.01);Ⅲ级组外周血PMP[302.76(268.05,445.02)个/μL)及其表面CD62p[47.20(35.35,56.43)%]表达水平高于Ⅰ、Ⅱ级组[107.86(135.60,320.52)个/μL、37.22(28.84,41.02)%,196.06(159.62,330.98)个/μL、33.04(28.81,46.23)%](P<0.01),Ⅱ、Ⅲ级组PAC-1[5.34(2.36,8.10)%、7.93(2.46,10.85)%]、CD40L[19.40(8.92,24.35)%、22.60(12.23,37.22)%]表达明显高于Ⅰ级组[2.44(1.98,4.33)%、10.00(6.22,17.39)%](P<0.05);logistic回归分析显示,PMP(OR=1.004,95%CI:-0.006~-0.001,P=0.011)及其表面CD62p(OR=1.046,95%CI:-0.087~-0.004,P=0.034)、PAC-1(OR=1.038,95%CI:-0.071~-0.004,P=0.030)、CD40L(OR=1.065,95%CI:-0.101~-0.025,P=0.001)表达水平升高是UA严重程度高的独立影响因素。结论 UA患者外周血PMP及其表面功能蛋白CD62p、PAC-1、CD40L表达水平升高与疾病严重程度高相关;PMP的黏附、聚集、促炎症反应作用参与UA的发生、发展。
Objective To investigate the relationship between platelet microparticle (PMP) and the expression of functional surface proteins CD62p, PAC-1, CD42b and CD40L in patients with unstable angina (UA) and the severity of UA. Methods One hundred and ten UA patients were divided into three groups according to the Braunwald classification: grade Ⅰ (35 cases), grade Ⅱ (37 cases) and grade Ⅲ (38 cases). 30 healthy controls were selected as the control group. The expression of functional protein CD62p, PAC-1, CD42b and CD40L on PMP and its surface were detected by flow cytometry, and the relationship between these indexes and the severity of UA was analyzed. Results The levels of PMP [220.35 (128.39,374.76) / μL] and its surface CD62p [37.22 (30.29,46.62)%], PAC-1 [19.30 (2.27,8.42)%] and CD40L [(15.61 , 24.02%] were significantly higher than those in the control group [78.21 (29.00, 115.18) /μL, 24.06 (16.00, 26.79)%, 0.82 (0.88,5.89)%, 3.75 (1.06,8.05)%] 0.01). The level of PMP [302.76 (268.05, 445.02) / μL) and the level of CD62p (47.20 (35.35,56.43)%] in grade Ⅲ group were higher than those in grade Ⅰ and Ⅱ group [107.86 (135.60, 320.52 (P <0.01), Ⅱ, Ⅲ grade group PAC-1 [5.34 (2.36,8.10)] / μL, 37.06 (28.84,41.02)%, 196.06 (159.62,330.98) /μL, 33.04(28.81,46.23)%] %, 7.93 (2.46,10.85)%], CD40L [19.40 (8.92,24.35)%, 22.60 (12.23,37.22)%] were significantly higher than those of grade Ⅰ [2.44 (1.98,4.33)%, 10.00 )%] (P <0.05). Logistic regression analysis showed that PMP (OR = 1.004,95% CI: -0.006-0.001, P = 0.011) and CD62p (OR = 1.046,95% CI -0.087 ~ (OR = 1.065, 95% CI: -0.101 -0.025, P = 0.001; P = 0.034, P = 0.034) ) Elevated expression levels are independent of the severity of UA. Conclusions The elevated levels of PMP and functional proteins CD62p, PAC-1 and CD40L in peripheral blood of UA patients are associated with the high severity of disease. The adhesion, aggregation and pro-inflammatory reaction of PMP are involved in the occurrence and development of UA.