| BackgroundWith the acceleration of urbanization and aging,and social,economic,dietary and environmental changes,as well as the prevalence of unhealthy lifestyle,the risk factors of coronary heart disease in China are generally exposed,showing a rapid growth trend of younger age in recent years.Although with the continuous improvement of the level of diagnosis,prevention and treatment,the prognosis of coronary heart disease has been significantly improved,and the mortality rate has shown a slowing down trend.However,on the whole,the morbidity and mortality of coronary heart disease in China are still in the.rising stage.At present,it is generally believed that coronary heart disease is a heart disease caused by coronary atherosclerosis with the participation of a variety of factors.However,the mechanism of coronary atherosclerosis is not fully understood.In recent years,the role of inflammation and immunity in atherosclerosis has been supported by a large amount of evidence.In recent years,the role of inflammatory and immune mechanisms in atherosclerosis has been supported by a large amount of evidence.Many studies have confirmed that inflammatory cells,inflammatory mediators,innate immunity and adaptive immunity are involved in the occurrence and development of atherosclerosis.Follicular helper T cellsare a group of newly discovered unique CD4+T cell subsets,including Tfh1,Tfh2 and Tfh17 subsets,the most important function of which is to assist B cells to proliferate,differentiate,convert and produce antibodies.Its dysfunction is closely related to the occurrence and development of some immune diseases,infectious diseases and tumors.In recent years,it has been found that Tfh cells can promote atherosclerosis in a variety of ways.And IL-21 is a pro-inflammatory factor secreted by CD4+T cells,which can act on a variety of immune and non-immune cells,it is involved in congenital and acquired immune responses under physiological conditions,as well as in inflammatory response,autoimmune diseases and infectious diseases.In addition,it has been found that Tfh cells can secrete IL-21,and affect the differentiation of Tfh cells by binding to IL-21R.However,the expression of Tfh cells and their subsets and IL-21 in peripheral blood of patients with coronary heart disease,whether it is related to the condition of coronary heart disease and the severity of coronary artery lesion,and whether it is a risk factor of coronary heart disease,has not been reported.ObjectiveTo detect the expression of Tfh cells and their subsets and IL-21 in peripheral blood of patients with coronary heart disease,and analyze the relationship between them andthe severity of coronary artery lesion and the risk of coronary heart disease,and its role in coronary heart disease was preliminarily discussed.Subjects and MethodsThe patients with coronary heart disease who were newly diagnosed in the Department of Cardiology of NanfangHospital and scheduled to undergo selective coronary angiography between August 2018 and December 2018 were collected for the study,the general status and clinical indexes were recorded in detail.The diagnosis of coronary heart disease was carried out in strict accordance with the guidelines issued by the Chinese Medical Association and the diagnostic criteria of WHO,and patients who met the inclusion and exclusion criteria were included in this study.According to the results of coronary angiography,84 patients were divided into normal control group(NC group,n=19)and coronary heart disease group(CHD group,n=65).Then according to the relevant guidelines and diagnostic criteria CHD group was divided into stable angina pectoris group(SAP group,n=16),unstable angina pectoris group(UAP group,n=18)and acute myocardial infarction group(AMI group,n=31).The fasting elbow venous blood samples in the morning following admission of study groups were obtained,and the expression levels of IL-21 were detected by ELISA method,and then the relationship between IL-21 and the severity of coronary artery lesion and the risk of coronary heart disease was analyzed.In addition,5?6ml anticoagulation fasting venous blood werecollected in the study groups from October 2018 to December 2018,including 10 cases in NC group,9 cases in SAP group,9 cases in UAP group and 15 cases in AMI group.PBMCs were isolated by Ficoll density gradient method,and Tfh cells and their subsets were detected by flow cytometry,and then the relationship between them and the severity of coronary artery lesion and the risk of coronary heart disease.At the same time,the coronary angiography of patients with coronary heart disease were evaluated by Gensini score,and the relationship between Gensini score and IL-21,Tfh cells and their subsets was analyzed.Results1.The expression of Tfh cells in peripheral blood of CHD group was significantly higher than that of NC group.There was no significant difference among SAP group,UAP group and AMI group,but all of them were significantly higher than that of NC group.2.The proportion of Tfh1 and Tfh17 cells in CHD group were significantly higher than them in NC group,but there was no significant difference in the proportion of Tfh2 cells.3.There was no significant difference in the proportion of Tfhl cells among SAP group,UAP group and AMI group,although all of three groups were higher than that in NC group,but only SAP group had statistical significance;while the proportion of Tfh2 cells decreased gradually compared with NC group,but the difference was not statistically significant.The proportion of Tfh17 cells increased gradually,AMI group and UAP group were significantly higher than that in NC group,and AMI group was significantly higher than SAP group,although SAP group had an increasing trend compared with NC group,but there was no statistical significance.4.The Gensini score of patients with coronary heart disease was positively correlated with Tfh17 cells,but not with Tfhl,Tfh2 and Tfh cells.Multivariate linear regression analysis showed that Tfhl 7 cells and LDL-C were the risk factors,while HDL-C was the protective factor.5.Multivariate binary Logistic regression analysis showed that Tfh17 cells were independent risk factorsfor coronary heart disease(OR=1.192,P=0.040,95%CI:1.034?1.601),while HDL-C was the independent protective factors(OR=0.415,P=0.021,95%CI:0.172?0.853).6.The level of IL-21 in CHD group was significantly higher than that in NC group,and AMI group was significantly higher than UAP group and SAP group,UAP group was also significantly higher than SAP group,while SAP group had an increasing trend compared with NC group,but the difference was not statistically significant.7.IL-21 was positively correlated with Tfh cells,Tfhl 7 cells,WBC,NEU and NT-proBNP,and negatively correlated with LVEF,but not with Gensini score.Multivariate binary Logistic regression analysis showed that IL-21 'was an independent risk factor(OR=1.174,P=0.024,95%CI:1.021?1.351)for coronary heart disease.Conclusion1.Tfh cells were overexpressed in peripheral blood of patients with coronary heart disease,and there was an imbalance of subsets,which mainly differentiated into Tfh17 cells.2.Tfh17 cells are the independent risk factors for CHD,participate in the occurrence and development of CHD,and are positively correlated with the severity of coronary artery lesion,which may have the effect of promoting atherosclerosis.3.Serum IL-21 were high expression in patients with coronary heart disease,which is an independent risk factor for CHD,and may be involved in the occurrence and development of CHD through inflammatory response or immune response.4.IL-21 was positively correlated with Tfh cells and Tfh17 cells.Tfh17 cells may be the important source of IL-21 in peripheral blood. |
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