Change Of Peripheral Blood CD4~+T Lymphocytes And Peri-procedural Myocardial Injury In Patients With Coronary Artery Disease

Objective To investigate the distribution change of peripheral blood CD4+T lymphocytes and underlying clinical significance in patients with acute coronary syndrome(ACS).Methods 219 clinical suspected coronary artery disease(CAD)inpatients were enrolled(07/2015--11/2016).All patients received coronary angiography(CAG).According to2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease,2014AHA/ACC guideline for the management of patients with NSTE-ACS and 2013ACCF/AHA guideline for the management of ST-elevation myocardial infarction,meanwhile,on the basis of CAG results,the patients were divided into three groups:non-obstructive CAD group(control group,n=63),stable CAD group(SCAD,n=55)and ACS group(n=101).The distribution proportion of CD4+T lymphocyte subsets including CD4+CD28null T cells,CD4+CD134+T cells and CD4+CD137+T cells were measured by flow cytometry.C-reactive protein(CRP)was determined by immune assay.Tumor necrosis factor-α(TNF-α)and tumor necrosis factor-related apoptosis-inducing ligand(TRAIL)in serum were detected by ELISA.Results(1)The distribution proportion of CD4+CD28null T cells in peripheral blood in ACS group was significantly higher than that in both control group((7.78±0.38)% vs.(2.40±0.24)%,P<0.05)and SCAD group((7.78±0.38)% vs.(2.32±0.24)%,P<0.05),but there was no difference between SCAD group and control group.(2)Both of the level of CRP and TNF-α in ACS group were significantly higher than those in control group((11.72±0.57)mg/L vs.(3.78±0.12)mg/L,P<0.05;(331.98±4.00)pg/m L vs.(272.67±5.60)pg/m L,P<0.05)and SCAD group((11.72±0.57)mg/L vs.(5.04±0.22)mg/L,P<0.05;(331.98±4.00)pg/m L vs.(296.84±7.67)pg/m L,P<0.05).However,the level of TRAIL in ACS group was significantly less than that in control group((437.41±7.84)pg/m L vs.(611.43±13.11)pg/m L,P<0.05)and SCAD group((437.41±7.84)pg/m L vs.(567.65±16.01)pg/m L,P<0.05).(3)In the overall subjects,the proportion of CD4+CD28null T cells in peripheral blood was positively correlated with serum CRP levels(r=0.657,P<0.05)and TNF-α levels(r=0.381,P<0.05).Contrary to this,it was inversely correlated with serum TRAIL levels(r=-0.467,P<0.05).(4)The distribution proportion of CD4+CD134+T cells in peripheral blood in ACS group was significantly higher than in control group((62.77±1.12)% vs.(46.36±1.85)%,P<0.05)and SCAD group((62.77±1.12)% vs.(53.48±1.32)%,P<0.05).The percentage of CD4+CD134+T cells in peripheral blood in SCAD group was also higher than in control group.(4)The distribution percentage of CD4+CD137+T cells in peripheral blood in ACS group was significantly higher than in control group((22.21±0.92)% vs.(14.67±1.02)%,P<0.05)and SCAD group((22.21±0.92)% vs.(14.49±0.89)%,P<0.05),but there was no difference between SCAD and control group.(5)In ACS patients,the proportion of CD4+CD28null T cells in peripheral blood was positively correlated with the expression of costimulatory molecules CD134(r=0.209,P<0.05)and CD137(r=0.241,P<0.05).Conclusion Prevalence of CD4+CD28null T cells,CD4+CD134+T cells and CD4+CD137+T cells in peripheral blood of ACS patients was significantly higher than in non-obstructive CAD and SCAD group.In ACS group,high frequencies of CD4+CD28null T cells were positively correlated with the expression of costimulatory molecules CD134,CD137,CRP and TNF-α,but inversely correlated with the level of serum TRAIL.Objective To investigate the relationship between the distribution proportion of peripheral blood CD4+CD28null T cells in PCI patients and the incidence of peri-procedural myocardial injury(PMI)after percutaneous coronary intervention(PCI).Methods 174 clinical suspected coronary artery disease(CAD)inpatients were enrolled(07/2015--11/2016).All patients received coronary angiography(CAG).According to2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease and 2014AHA/ACC guideline for the management of patients with NSTE-ACS,meanwhile,on the basis of CAG results,the patients were divided into two groups: non-obstructive CAD group(control group,n=63)and CAD group(n=111).All CAD patients received PCI for the first time.In line with 2012 ESC/ACCF/AHA/WHF guideline for third universal definition of myocardial infarction,CAD patients received PCI were divided into two groups: PMI group(n=32)and non-PMI group(n=79).Immunofluorescence method was used to determined serum cardiac troponin I(c Tn I).The distribution proportion of CD4+CD28null T cells was measured by flow cytometry.Results(1)The distribution proportion of CD4+CD28nullT cells in peripheral blood in CAD group was higher than that in control group((5.30±0.40)% vs.(2.40±0.24)%)and the difference is significant(P<0.05).(2)In all CAD patients,there was no correlation between the proportion of CD4+CD28null T cells in peripheral blood and serum c Tn I before PCI(r=0.072,P=0.455),but it was was positively correlated with serum c Tn I levels after PCI(r=0.275,P=0.004).(3)The incidence of PMI after PCI was28.8% in this study.The distribution proportion of CD4+CD28null T cells in PMI group was higher than in non-PMI group((7.32±0.85)% vs.(4.48±0.41)%,P<0.05).(4)Binary logistic regression analysis showed that the distribution proportion of CD4+CD28null T cells was a risk factor of the incidence of PMI(OR=1.173,95% CI1.050~1.311,P=0.005).That was to said that the higher proportion of CD4+CD28null T cells,the risk of developing PMI would be increased more significantly.(5)In PMI group,the distribution proportion of CD4+CD28null T cells in three or more than coronary artery lesions group and two coronary artery lesions group were both higher than in one coronary artery lesions group((9.97±1.36)% vs.(1.80±0.46)%,P<0.05;(9.09±0.96)% vs.(1.80±0.46)%,P<0.05;respectively).(6)In all CAD patients,there was difference during three different coronary artery lesions groups about the incidence of PMI.In addition,the proportion of CD4+CD28null T cells in three or more than coronary artery lesions group and two coronary artery lesions group were still both higher than in one coronary artery lesions group((7.30±0.91)% vs.(3.33±0.42)%,P<0.05;(6.92±0.69)% vs.(3.33±0.42)%,P<0.05;respectively).Conclusion Prevalence of CD4+CD28null T cells in peripheral blood of CAD patients was significantly higher,and it was a risk factor of the incidence of PMI.In addition,the more lesions of coronary artery,the frequency of CD4+CD28null T cells was higher.They all suggested that immune inflammatory response may be involved in the occurrence of PMI,and CAD patients with basic high inflammatory status may increase the relative risk of incidence of PMI.