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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2019, Vol. 13 ›› Issue (09) : 664 -668. doi: 10.3877/cma.j.issn.1674-0785.2019.09.005

所属专题： 文献；

临床研究

可溶性共刺激分子程序性死亡因子1表达与颈动脉粥样硬化斑块形成的相关性
顾静1, 方勇1, 陆燕1, 朱一蓓2,†()   
  1. 1. 214065　江苏无锡，上海市华东疗养院内科
    2. 215123　苏州大学医学部基础医学与生物科学学院免疫学系
  • 收稿日期:2019-03-19 出版日期:2019-05-01
  • 通信作者: 朱一蓓

Association between serum soluble costimulatory molecule programmed cell death-1 and carotid atherosclerosis

Jing Gu1, Yong Fang1, Yan Lu1, Yibei Zhu2,†()   

  1. 1. Department of Medicine, Shanghai Huadong Sanatorium, Wuxi 214065, China
    2. Department of Immunology, Medicine College of Soochow University, Suzhou 215123, China
  • Received:2019-03-19 Published:2019-05-01
  • Corresponding author: Yibei Zhu
  • About author:
    Corresponding author: Zhu YiBei, Email:
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引用本文：

顾静, 方勇, 陆燕, 朱一蓓. 可溶性共刺激分子程序性死亡因子1表达与颈动脉粥样硬化斑块形成的相关性[J]. 中华临床医师杂志(电子版), 2019, 13(09): 664-668.

Jing Gu, Yong Fang, Yan Lu, Yibei Zhu. Association between serum soluble costimulatory molecule programmed cell death-1 and carotid atherosclerosis[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(09): 664-668.

目的

探讨血清可溶性共刺激分子程序性死亡因子1（sPD-1）与颈动脉粥样硬化（CAS）斑块的相关性。

方法

选择2016年1月至12月在上海市华东疗养院接受体检的69例CAS斑块患者作为CAS组，另外选择72名非CAS斑块者作为对照组，应用酶联免疫吸附试验检测所有研究对象的血清sPD-1的浓度。采用t检验比较2组受检者血清sPD-1的差异，采用Pearson或Spearman法分析血清sPD-1与临床各指标［年龄、性别、吸烟、饮酒、体质量指数（BMI）、腰臀比、收缩压、舒张压、三酰甘油、总胆固醇、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、糖化血红蛋白（HbA1c）、脂蛋白a、空腹血糖］的相关性以及CAS组中斑块Crouse积分与各指标的相关性，采用二元Logistic回归对CAS斑块行危险因素分析；使用ROC曲线分析sPD-1预测CAS斑块形成的诊断价值。

结果

CAS组sPD-1水平高于对照组［（1.26±1.01）μg/L vs （0.64±0.49）μg/L］，差异具有统计学意义（t=4.598，P<0.001）；sPD-1与BMI、腰臀比、三酰甘油、空腹血糖、HbA1c呈正相关（P<0.05），与HDL-c、脂蛋白α呈负相关（P<0.05）；斑块Crouse积分与年龄、SBP呈正相关（P<0.05），与TG呈负相关（P<0.05）；年龄、性别、饮酒、LDL-c、舒张压sPD-1是CAS斑块形成的危险因素；ROC曲线分析显示sPD-1对于颈动脉粥样硬化斑块形成有中等诊断价值（P<0.05）。

结论

sPD-1可能在CAS斑块的形成、发展的炎症过程中发挥作用，sPD-1对预测CAS斑块形成有诊断价值。

关键词: 可溶性共刺激分子, 程序性死亡因子1, 颈动脉粥样硬化斑块
Objective

To investigate the association between serum soluble costimulatory molecule programmed death factor 1 (sPD-1) and carotid atherosclerosis (CAS).

Methods

Sixty-nine patients with CAS plaques who underwent physical examination at Shanghai Huadong Sanatorium from January to December 2016 were selected as a study group (CAS group), and another 72 patients without CAS plaques were selected as a control group. Enzyme-linked immunosorbent assay was used to detect the concentrations of serum sPD-1. The t-test was used to compare the difference of serum sPD-1 between the two groups. Pearson or Spearman method was used to analyze the correlations of serum sPD-1 with age, gender, smoking, alcohol consumption, body mass index (BMI), waist hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), triacylglycerol (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), glycosylated hemoglobin (HbA1c), lipoprotein a [Lp(a)], and fasting blood glucose (FBG). Pearson or Spearman method was also used to analyze the correlation between plaque Crouse score and various indicators in the CAS group. The risk factors for CAS plaque were identified by binary Logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic value of sPD-1 in predicting CAS plaque formation.

Results

The concentration of sPD-1 in the CAS group was significantly higher than that in the control group ([1.26±1.01] μg /L vs [0.64±0.49] μg/L, t=4.598, P<0.001). SPD-1 was positively correlated with age, BMI, WHR, TG, FBG, and HbA1c (P<0.05), and negatively correlated with gender (male as the reference), HDL-c, and LP(a) (P<0.05). Plaque Crouse score was positively correlated with age and SBP (P<0.05), and negatively correlated with TG (P<0.05). Age, drinking, LDL-c, and sPD-1 were identified to be risk factors for CAS plaque formation. ROC curve analysis showed that sPD-1 had medium diagnostic value for carotid atherosclerotic plaque formation (P<0.05).

Conclusion

sPD-1 may play a role in the formation and development of CAS plaques, and it has appreciated diagnostic value in predicting the formation of CAS plaques.

Key words: Soluble costimulatory molecule, Programmed cell death-1, Carotid atherosclerosis plaque
表1 CAS组与对照组一般资料、生化指标及sPD-1浓度的比较
组别 例数 男性［例（%）］ 年龄（岁，±s） 吸烟［例（%）］ 饮酒［例（%）］ BMI（kg/m2，±s）
CAS组 69 49（71.0） 60.75±10.74 24（34.8） 31（44.9） 25.38±3.17
对照组 72 52（72.2） 58.26±9.80 14（19.4） 5（6.9） 23.96±3.51
统计值 ? χ2=0.814 t=1.437 χ2=4.210 χ2=26.736 t=2.512
P值 ? 0.376 0.153 0.040 <0.001 0.013
组别 例数 腰臀比（±s） 收缩压（mmHg，±s） 舒张压（mmHg，±s） 三酰甘油（mmol/L，±s） 总胆固醇（mmol/L，±s）
CAS组 69 0.89±0.05 131.46±18.11 74.6±10.49 2.22±2.41 5.19±1.16
对照组 72 0.85±0.05 121.94±16.66 71.74±9.25 1.82±1.30 5.12±0.92
统计值 ? t=4.161 t=3.244 t=1.727 t=1.228 t=0.410
P值 ? <0.001 0.001 0.086 0.222 0.681
组别 例数 LDL-c（mmol/L，±s） HDL-c （mmol/L，±s） 脂蛋白α［mg/dl，M（QR）］ HbA1c（%，±s） 空腹血糖（mmol/L，±s） sPD-1（μg/L，±s）
CAS组 69 3.10±0.71 1.30±0.36 6.10（3.60~21.40） 6.31±1.07 6.87±1.79 1.26±1.01
对照组 72 3.08±0.75 1.42±0.46 10.10（5.10~19.50） 6.36±1.11 6.91±1.74 0.64±0.49
统计值 ? t=0.181 t=1.679 Z=0.797 t=0.279 t=0.135 t=4.598
P值 ? 0.857 0.095 0.426 0.781 0.893 <0.001
表2 颈动脉粥样硬化斑块形成的影响因素
变量 β值 SE值 Wals值 P值 OR值 95%可信区间
年龄 0.143 0.036 15.952 0.000 1.154 1.076~1.238
性别 -2.428 1.052 5.326 0.021 0.088 0.011~0.693
吸烟 -0.984 0.810 1.476 0.224 0.374 0.076~1.828
饮酒 -2.894 0.848 11.638 0.001 0.055 0.010~0.292
BMI -0.073 0.138 0.281 0.596 0.929 0.709~1.218
腰臀比 -0.115 10.534 0.000 0.991 0.891 0.000~8.480
收缩压 0.001 0.048 0.000 0.991 1.001 0.991~1.099
舒张压 0.077 0.037 4.386 0.036 1.080 1.005~1.160
三酰甘油 -1.016 0.717 2.008 0.156 0.362 0.089~1.476
总胆固醇 4.451 2.592 2.949 0.086 8.567 0.533~1.376
LDL-c -5.170 2.555 4.093 <0.001 0.006 0.000~0.851
HDL-c -4.927 2.613 3.556 0.059 0.007 0.000~1.214
脂蛋白a 0.028 0.024 1.319 0.251 1.028 0.981~1.077
空腹血糖 -0.039 0.354 0.012 0.912 0.961 0.480~1.924
HbA1c -0.274 0.593 0.213 0.644 0.761 0.238~2.430
sPD-1 2.481 0.801 9.583 0.002 11.955 2.485~57.518
图1 血清sPD-1预测动脉粥样硬化斑块形成ROC曲线
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