冠状动脉扩张患者淋巴细胞和单核细胞亚型分析

doi:10.16138/j.1673-6087.2022.05.005

摘要/Abstract

摘要：

目的：初步确定外周淋巴细胞和单核细胞是否参与了冠状动脉（冠脉）扩张(coronary artery ectasia, CAE)的病理过程,以推测CAE是否为免疫性疾病。方法：纳入2017年1月至2018年1月接受冠脉造影并确诊的34例CAE患者,利用抽签法纳入同日期接受冠脉造影的30例冠心病（coronary heart disease,CHD）患者和32例冠脉相对正常的受试者（对照组）。各组之间年龄、性别和其他基线特征基本平衡,通过流式细胞法检测外周血样中的淋巴细胞和单核细胞亚型。结果：CAE和CHD患者的外周血淋巴细胞亚型差异无统计学意义,但与CHD和对照组相比,CAE组的炎症型（非经典型）单核细胞比例显著增加[26.45%（16.90%~44.55%）,13.70%（9.33%~17.60%）,7.00%（13.70%~29.40%）,P=0.000],经典型单核细胞比例显著降低[66.35%（39.73%~78.83%）,82.90%（80.50%~89.40%）,78.30%（56.70%~83.80%）,P=0.000]。多重线性回归分析进一步证实了非经典单核细胞比例增加与CAE相关[定义CAE组=1,CHD组=2,对照组=3,故回归系数为负,即β=-0.371,P=0.000]。结论：CAE更可能是炎症性疾病,而不是免疫性疾病。

关键词: 冠状动脉扩张, 淋巴细胞, 单核细胞, 炎症

Abstract:

Objective To determine whether peripheral lymphocytes and monocytes were involved in the pathological processes of coronary artery ectasia (CAE). Methods This study included 34 patients who underwent coronary angiography and were diagnosed as CAE from January 2017 to January 2018. In addition, a total of 30 patients with coronary heart disease (CHD) and 32 subjects with relatively normal coronary arteries (control group) who underwent coronary angiography on the same period were included by lot. Three groups were balanced according to age, sex, and other baseline characteristics, and the lymphocyte and monocyte subtypes in their blood samples were examined via flow cytometry. Results Lymphocyte subtypes in CAE and CHD patients showed no significant differences. However, compared to the CHD and control groups, the inflammatory (non-classic type) monocytes were significantly increased [26.45% (16.90%-44.55%) vs 13.70%(9.33%-17.60%), or 7.00% (13.70%-29.40%), P=0.000], while the classic subtype monocytes were significantly decreased [66.35% (39.73%-78.83%) vs 82.90% (80.50%-89.40%) or 78.30% (56.70%-83.80%), P=0.000] in the CAE group. Multiple linear regression analysis further confirmed that the non-classic monocyte was related to CAE [CAE group=1, CHD group=2, control group=3, so the regression coefficient is negative as β=-0.371, P=0.000 ]. Conclusions CAE could be an inflammatory disease rather than an immune disease.

Key words: Coronary artery ectasia, Lymphocyte, Monocyte, Inflammation

中图分类号:

R543.3

刘锐锋, 盛倩倩, 张悦, 赵慧强. 冠状动脉扩张患者淋巴细胞和单核细胞亚型分析[J]. 内科理论与实践, 2022, 17(05): 373-378.

LIU Ruifeng, SHENG Qianqian, ZHANG Yue, ZHAO Huiqiang. Lymphocyte and monocyte subtypes in coronary artery ectasia patients[J]. Journal of Internal Medicine Concepts & Practice, 2022, 17(05): 373-378.

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指标	对照组（n=32）	CHD组（n=30）	CAE组（n=34）	F/χ²/Z	P
年龄（岁）	60.53±5.22	63.43±6.75	63.53±8.42	1.818	0.168
男性[n（%）]	17(56.7)	18(60.0)	19(63.3)	0.870	0.870
高血压[n（%）]	21(70.0)	26(86.7)	26(86.7)	0.174	0.174
收缩压（mmHg）	121.30±13.04	129.28±19.51	124.57±14.6	1.870	0.160
舒张压（mmHg）	72.83±8.47	77.14±19.19	75.37±11.94	0.720	0.490
糖尿病[n（%）]	4(13.3)	14(46.7)	20(66.7)	0.000	0.000
糖化血红蛋白（%）	5.98±0.96	6.64±1.22	6.37±1.06	2.522	0.087
吸烟[n（%）]	15(50.0)	13(43.3)	14(46.7)	0.866	0.865
饮酒[n（%）]	10(33.3)	11(36.7)	5(16.7)	0.216	0.216
CHD家族史[n（%）]	5(16.6)	12(40.0)	9(30.0)	0.134	0.134
高血压家族史[n（%）]	8(26.7)	14(46.7)	7(23.3)	0.127	0.127
BMI（kg/m²）	27.00(24.30, 29.00)	26.30(23.81, 27.66)	27.00(25.25, 28.07)	0.413	0.285
ALT（U/L）	23.10(16.50, 27.50)	18.00(13.00, 21.00)	17.00(12.00, 32.00)	2.916	0.066
AST（U/L）	19.60(16.00, 23.00)	18.65(15.00, 23.00)	18.70(17.35, 21.70)	2.690	0.543
尿素氮（mmol/L）	74.90(69.20, 89.50)	82.80(70.50, 88.40)	78.90(66.33, 91.53)	0.193	0.796
血肌酐（μmol/L）	4.82(4.16, 6.18)	5.41(4.51, 6.27)	5.07(4.13, 6.86)	0.579	0.577
TC（mmol/L）	4.31(3.47, 4.79)	3.85(3.36, 4.85)	3.85(3.42, 4.84)	0.075	0.743
TG（mmol/L）	1.40(0.88, 2.52)	1.50(1.07, 1.82)	1.42(1.04, 1.90)	0.185	0.942
HDL-C（mmol/L）	1.11(0.87, 1.36)	1.01(0.87, 1.28)	0.95(0.82, 1.14)	2.372	0.147
LDL-C（mmol/L）	2.25(1.73, 2.70)	2.07(1.85, 2.60)	2.06(1.77, 2.70)	0.374	0.858

指标	对照组（n=32）	CHD组（n=30）	CAE组（n=34）	F/χ²/Z	P
白细胞（×10⁹/L）	6.52±1.43	7.22±2.02	6.72±1.37	1.455	0.239
淋巴细胞（×10⁹/L）	1.85±0.53	1.88±0.53	1.97±0.02	0.429	0.652
单核细胞（×10⁹/L）	0.42±0.12	0.41±0.13	0.41±0.13	0.001	0.999
中性粒细胞（×10⁹/L）	4.09±1.19	4.72±1.89	4.27±1.03	1.583	0.211
NL比值	2.40±1.03	2.69±1.28	2.30±0.781	1.185	0.324
嗜碱性粒细胞（×10⁹/L）	0.04±0.02	0.04±0.02	0.04±0.02	0.292	0.747
嗜酸性粒细胞（×10⁹/L）	0.137±0.066	0.154±0.139	0.128±0.086	0.500	0.608
hs-CRP（mg/L）	1.29(0.46, 1.61)	1.50(0.80, 3.07)	1.30(0.68, 3.59)	0.497	0.339
ESR（mm/1h）	7.00(4.00, 9.50)	8.50(6.75, 12.25)	9.00(6.00, 15.00)	0.892	0.190
总胆红素（mmol/L）	12.98(9.98, 16.00)	12.63(10.30, 17.32)	13.81(11.09, 17.91)	0.776	0.470
直接胆红素（mmol/L）	2.05(1.69, 3.13)	2.52(1.69, 2.99)	2.57(1.98, 3.38)	0.092	0.685
间接胆红素（mmol/L）	10.09(7.87, 14.21)	10.03(7.79, 14.25)	10.92(8.82, 14.18)	0.344	0.452
左主干狭窄[n（%）]	-	3(10.0)	0(0.0)	3.450	0.063
前降支狭窄[n（%）]	-	25(83.3)	29(85.3)	0.249	0.618
回旋支狭窄[n（%）]	-	21(70.0)	19(55.9)	0.964	0.326
右冠脉狭窄[n（%）]	-	21(70.0)	26(76.5)	0.671	0.432
Gensini评分	-	39.00(34.50, 54.00)	36.50(31.00, 59.25)	-0.828	0.408
前降支的TFC（帧）	28.00(23.00, 35.00)	28.00(22.00, 39.00)	39.50(33.00, 48.25)	17.388	0.000
回旋支的TFC（帧）	30.00(23.00, 33.00)	25.00(19.00, 37.00)	37.50(28.75, 52.25)	11.098	0.000
右冠脉的TFC（帧）	25.00(20.00, 30.00)	21.00(18.00, 31.00)	30.00(24.00, 44.00)	10.529	0.002
左主干扩张[n（%）]	-	-	7(20.6)		-
前降支扩张[n（%）]	-	-	19(55.9)		-
回旋支扩张[n（%）]	-	-	16(47.1)		-
右冠脉扩张[n（%）]	-	-	26(76.5)		-

指标	对照组（n=32）	CHD组（n=30）	CAE组（n=34）	P	P1	P2	P3
CD3⁺CD4⁺淋巴细胞	41.10(26.70, 52.30)	60.20(51.30, 72.83)	58.30(47.45, 68.10)	0.000	0.371	0.000	0.000
CD3⁺CD8⁺淋巴细胞	24.30(18.10, 30.60)	28.10(22.78, 34.65)	31.25(23.23, 37.95)	0.091	0.371	0.039	0.147
CD16⁺淋巴细胞	13.20(8.35, 21.60)	18.00(11.10, 21.70)	14.90(10.53, 20.90)	0.215	0.386	0.398	0.076
CD19⁺淋巴细胞	3.02(1.30, 5.26)	4.67(1.92, 6.70)	3.02(1.81, 8.17)	0.349	0.545	0.479	0.128
经典型单核细胞	78.30(56.70, 83.80)	82.90(80.50, 89.40)	66.35(39.73, 78.83)	0.000	0.000	0.060	0.006
中间型单核细胞	1.03(0.35, 5.94)	0.00(0.00, 0.00)	1.47(0.22, 3.76)	0.000	0.000	0.497	0.000
非经典型单核细胞	17.00(13.70, 29.40)	13.70(9.33, 17.60)	26.45(16.90, 44.55)	0.000	0.000	0.046	0.015

项目	β	95%置信区间		标准化β	t	P
常数	79.011	23.378	134.643		2.889	0.007
组别（CAE组=1,CHD组=2,对照组=3）	-8.589	-16.284	-0.894	-0.371	-2.271	0.030
高血压（无=0, 有=1）	-24.608	-42.003	-7.214	-0.494	-2.878	0.007
中性粒细胞	4.650	1.095	8.205	0.412	2.661	0.012
ESR	0.732	0.124	1.339	0.386	2.451	0.020
Gensini评分	-0.278	-0.556	-0.001	-0.332	-2.040	0.049