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目的:探讨非ST段抬高性急性冠状动脉综合征(ACS)患者外周血淋巴细胞表达OX40L及血浆可溶性OX40L(sOX40L)水平与再发缺血事件的关系。方法:选取我院336例非ST段抬高性ACS住院患者,收集患者基线资料及180d内发生急性心肌梗死(AMI)及因ACS再住院情况,对患者入院时血淋巴细胞表达OX40L、血浆sOX40L水平、高敏C反应蛋白(hs-CRP)水平进行检测;分析OX40L在淋巴细胞上的表达、血浆OX40L水平与再发缺血事件的关系并与CRP及预后的关系相比较。结果:外周血淋巴细胞OX40L高表达水平者随访30d(P<0.05)、高hs-CRP水平者30d(P<0.05)再缺血事件发生率高,Kaplan-Meier生存分析显示,较高淋巴细胞OX40L表达对30d预后的预测作用与较低水平者差异有统计学意义,淋巴细胞OX40L表达较hs-CRP水平更能提示近期预后。Logistic回归分析显示:年龄(OR:2.37,95%CI 1.10～4.81,P<0.05)、血糖水平(OR:2.46,95%CI1.16～4.92,P<0.05)、淋巴细胞OX40L表达水平(OR:4.20,95%CI 2.41～7.09,P<0.05)、血清hs-CRP(3.46,95%CI 1.39～7.82,P<0.05)为随访30d内再缺血事件发生的独立预测因素。结论:ACS患者急性期淋巴细胞OX40L表达、血清sOX40L水平可预测近期再缺血事件。
Objective: To investigate the relationship between OX40L expression in peripheral blood lymphocytes and soluble OX40L (sOX40L) levels in patients with non-ST-elevation acute coronary syndrome (ACS) and recurrent ischemic events. Methods: A total of 336 hospitalized patients with non-ST-segment elevation ACS were enrolled in this study. Baseline data and acute myocardial infarction (AMI) within 180 days were collected and re-hospitalized due to ACS. OX40L and sOX40L The level of hs-CRP and the level of hs-CRP were detected. The expression of OX40L on lymphocytes, the level of plasma OX40L and the relapse of ischemic events were compared with those of CRP and prognosis. Results: The high expression level of OX40L in peripheral blood lymphocytes was followed up for 30 days (P <0.05), and the high hs-CRP level was higher in 30 days (P <0.05). Kaplan-Meier survival analysis showed that higher lymphocytes The predictive value of OX40L expression on the 30d prognosis was significantly different from that of the lower level. The expression of OX40L in lymphocytes was more suggestive of the recent prognosis than the hs-CRP level. Logistic regression analysis showed that the level of OX40L in lymphocytes (OR: 2.37, 95% CI 1.10-4.81, P <0.05) : 4.20, 95% CI 2.41-7.09, P <0.05). Serum hs-CRP (3.46,95% CI 1.39-7.82, P <0.05) was an independent predictor of rebleeding events within 30 days of follow-up. Conclusion: The expression of OX40L in acute stage of ACS patients and the level of sOX40L in serum can predict recent reperfusion events.