Chen Mien-Cheng, Chang Hsueh-Wen, Wu Chiung-Jen, Yang Cheng-Hsu, Hung Wei Chin, Yeh Kuo-Ho, Fu Morgan
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, 123Ta Pei Rd, Niao Sung Hsiang, Kaohsiung Hsien 83301, Taiwan, ROC.
Chest. 2005 Jul;128(1):36-41. doi: 10.1378/chest.128.1.36.
Recent data suggest that the pathogenesis of vascular inflammation and thrombosis involves CD40 ligand (CD40L), which is mostly derived from platelets. Previous studies have demonstrated that platelet activation occurs in peripheral blood of patients with rheumatic mitral stenosis (MS). However, in patients with MS, the plasma level of soluble CD40L has never been investigated.
Seventeen patients with symptomatic MS undergoing percutaneous transluminal mitral valvuloplasty were studied (group 1, 11 patients in permanent atrial fibrillation and 6 patients in sinus rhythm). Solid-phase, sandwich enzyme-linked immunosorbent assay determined the plasma levels of soluble CD40L in the femoral vein and artery, and right and left atria before valvuloplasty, and those in the peripheral venous blood obtained 10 min after valvuloplasty, and at the 4-week follow-up after valvuloplasty. The Doppler pressure half-time method was used to calculate the mitral valve area. Additionally, plasma concentrations of soluble CD40L in the peripheral venous blood obtained from 17 control patients were measured (including nine healthy volunteers in sinus rhythm [group 2] and eight patients in permanent lone atrial fibrillation [group 3]). Plasma levels of soluble CD40L were significantly elevated in group 1 patients (437.6 +/- 370.2 pg/mL) [mean +/- SD] compared with group 2 (203.8 +/- 218.0 pg/mL) and group 3 patients (173.5 +/- 105.0 pg/mL) [p < 0.05]. The area of mitral valve increased significantly after valvuloplasty (1.10 +/- 0.20 cm(2) vs 1.47 +/- 0.29 cm(2), p < 0.0001). The mean left atrial pressure fell significantly and immediately after valvuloplasty (22.8 +/- 4.9 mm Hg vs 17.6 +/- 5.5 mm Hg, p = 0.0004). The peripheral venous plasma levels of soluble CD40L obtained before valvuloplasty significantly fell after valvuloplasty (before, 437.6 +/- 370.2 pg/mL; vs 10 min after, 215.4 +/- 113.9 pg/mL; vs 4 weeks after, 217.5 +/- 111.9 pg/mL; p < 0.02).
Patients with moderate-to-severe MS had higher venous plasma levels of soluble CD40L than healthy volunteers or patients with lone atrial fibrillation. Additionally, the elevated venous plasma levels of soluble CD40L fell significantly following valvuloplasty.
最近的数据表明，血管炎症和血栓形成的发病机制涉及CD40配体（CD40L），其主要来源于血小板。先前的研究已证明，风湿性二尖瓣狭窄（MS）患者外周血中会发生血小板激活。然而，MS患者的可溶性CD40L血浆水平从未被研究过。
对17例有症状的MS患者进行经皮腔内二尖瓣成形术（第1组，11例永久性房颤患者和6例窦性心律患者）。采用固相夹心酶联免疫吸附测定法，在瓣膜成形术前测定股静脉、动脉以及左右心房中可溶性CD40L的血浆水平，在瓣膜成形术后10分钟以及瓣膜成形术后4周随访时测定外周静脉血中的可溶性CD40L水平。采用多普勒压力半衰期法计算二尖瓣面积。此外，还测定了17例对照患者外周静脉血中可溶性CD40L的血浆浓度（包括9例窦性心律的健康志愿者[第2组]和8例永久性孤立性房颤患者[第3组]）。与第2组（203.8±218.0 pg/mL）和第3组患者（173.5±105.0 pg/mL）相比，第1组患者的可溶性CD40L血浆水平显著升高（437.6±370.2 pg/mL）[均值±标准差] [p<0.05]。瓣膜成形术后二尖瓣面积显著增加（1.10±0.20 cm²对1.47±0.29 cm²，p<0.0001）。瓣膜成形术后左心房平均压力立即显著下降（22.8±4.9 mmHg对17.6±5.5 mmHg，p = 0.0004）。瓣膜成形术前外周静脉血浆中可溶性CD40L水平在瓣膜成形术后显著下降（术前，437.6±370.2 pg/mL；术后10分钟，215.4±113.9 pg/mL；术后4周，217.5±111.9 pg/mL；p<0.02）。
中重度MS患者的静脉血浆可溶性CD40L水平高于健康志愿者或孤立性房颤患者。此外，瓣膜成形术后静脉血浆中升高的可溶性CD40L水平显著下降。
