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目的:研究急性冠状动脉综合征(ACS)患者妊娠相关血浆蛋白A(PAPP-A)血清水平和外周血单核细胞表达的变化及其与C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)的相关性。方法:测定18例不稳定型心绞痛(UAP组)、37例急性心肌梗死(AMI组)和15例稳定型心绞痛(SAP组)及15例正常对照者(对照组)的血清PAPP-A、高敏CRP(hsCRP)和TNF-α水平。同时分离外周血单核细胞,应用RT-PCR检测PAPP-A和TNF-α的mRNA表达。结果:SAP组血清hsCRP和TNF-α水平明显高于对照组;UAP组明显高于对照组和SAP组,但低于AMI组。SAP组血清PAPP-A水平和单核细胞PAPP-A的mRNA表达水平与对照组相比,差异无统计学意义;而在UAP组和AMI组均显著高于对照组和SAP组(均P<0.01)。ACS组患者的血清PAPP-A水平与血清hsCRP和TNF-α水平均呈显著正相关(r=0.616,r=0.712,P<0.01),同时外周血单核细胞PAPP-AmR-NA表达水平与血清hsCRP水平及TNF-αmRNA表达水平均呈显著正相关(r=0.706,r=0.733,P<0.01)。结论:PAPP-A可能是由活化的单核细胞合成并分泌到动脉粥样硬化斑块内和血循环中,并与炎症密切相关。
Objective: To study the changes of serum levels of pregnancy related plasma protein A (PAPP-A) and the expression of peripheral blood mononuclear cells in patients with acute coronary syndrome (ACS) and the relationship between the levels of C reactive protein (CRP) and tumor necrosis factor-α -α). Methods: The serum levels of PAPP-A in 18 cases of unstable angina pectoris (UAP group), 37 cases of acute myocardial infarction (AMI group) and 15 cases of stable angina pectoris (SAP group) and 15 cases of normal control group (control group) CRP (hsCRP) and TNF-α levels. Peripheral blood mononuclear cells were isolated at the same time, and the mRNA expressions of PAPP-A and TNF-α were detected by RT-PCR. Results: The levels of serum hsCRP and TNF-α in SAP group were significantly higher than those in control group. The levels in serum of UAP group were significantly higher than those in control group and SAP group, but lower than those in AMI group. Compared with control group, PAPP-A level in PAP group and PAPP-A mRNA expression level in SAP group were significantly higher than those in control group and SAP group (P < 0.01). Serum PAPP-A levels in patients with ACS were significantly and positively correlated with serum hsCRP and TNF-α levels (r = 0.616, r = 0.712, P <0.01), while the levels of PAPP-AmR-NA in peripheral blood mononuclear cells Serum hsCRP levels and TNF-α mRNA expression levels were significantly correlated (r = 0.706, r = 0.733, P <0.01). Conclusion: PAPP-A may be synthesized and secreted by activated monocytes into atherosclerotic plaque and blood circulation, and is closely related to inflammation.