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目的：探讨血清可溶性白细胞分化抗原40配体（sCD40L ）检测联合血管内超声（IVUS）评价冠心病风险的价值。方法180例冠心病患者分为稳定型心绞痛组（SA组，75例）和不稳定型心绞痛组（U A组，105例）；另选45例冠脉造影检查阴性患者为对照组。冠心病患者行IV U S检查，对斑块形态进行判定；ELISA法检测血清sCD40L水平。结果 UA组血清sCD40L水平高于SA组及对照组（P＜0．01）。IVUS显示，UA组以易损、偏心斑块为主，斑块部位血管多发生正性重构；SA组以稳定型、向心性斑块为主，斑块部位血管多发生负性重构。易损斑块、偏心斑块及正性重构患者血清sCD40L水平分别高于稳定斑块、向心斑块及负性重构和无重构患者（ P＜0．01）；而血清sCD40L水平与冠状动脉狭窄程度无明显相关（ r＝0．0965，P＞0．05）。结论检测血清sCD40L水平联合IV U S能更好地评价冠心病风险，预测急性冠状动脉事件。“,”Objective To evaluate the significance of serum soluble CD40 ligand (sCD40L ) detection combined with intravascular ultrasound (IVUS ) in evaluating the risk of coronary heart disease(CHD) .Methods A total of 180 patients with CHD was divided into two groups of SA (with stable angina ,75 cases) and UA(with unstable angina ,105 cases) .Another 45 patients without CHD confirmed by coronary angiography were taken as the controls (group C) .The coronary atherosclerotic plaques of CHD patients were observed by IVUS ,and the serum level of sCD40L was detected by ELISA .Results Serum level of sCD40L in group UA was higher than that in groups of SA and C (P<0 .01) .IVUS showed that the plaques in group UA were mostly vulnerable ,eccentric and positive remodeling ,which in group SA were stable ,concentric and negative remodeling .Serum levels of sCD40L in CHD patients with vulnerable ,eccentric plaques and positive remodeling were higher than those with stable ,concentric plaques and negative/intermediate remodeling ,respectively (P0 .05) .Conculsion Detection of serum sCD40L in combination with IVUS can be better for evaluating the risk of CHD and predicting acute coronary events .