The Relationship Between TLR4 Protein Expression Of Peripheral Blood Monocytes And The Pathogenetic Condition And Prognosis In Patients With Acute Coronary Syndrome

Objective: To study Toll-like receptor4 (TLR4) protein expression levels in peripheral blood mononuclear cells (PBMCs) in patients with acute coronary syndrome (ACS) and stable angina pectoris (SAP) and the prognostic significance. Also to compare the prognostic value of TLR4 protein and GRACE score in patients with acute coronary syndrome, to seek sensitive index of prognosis in those patients.Methods: TLR4 gene expression levels were examined in PBMCs (CD14+ monocytes) using flow cytometry in 273 cases including 182 ACS patients, 48 SAP and 43 control subjects. GRACE score and Gensini score of admitted patients were calculated. The endpoints were follow- up of ACS patients after one year. The receiver operating characteristic curve (ROC) was used to evaluate prognostic value of TLR4 protein and GRACE score. The logistic regression model was used to assess the prognostic value of TLR4 protein and GRACE score.Results: TLR4 protein expression of peripheral blood monocytes was significantly higher in ACS patients than the SAP patients and the controls (32.41±9.67vs13.80±4.90 vs10.24±3.95 respectively, p<0.05). In the acute phase of ACS patients, partial correlation analysis showed significant correlation between TLR4 protein and the GRACE score (Pearson correlation coefficient r=0.388, P=0.00), Gensini score (r=0.718, P=0.00), cTnI (r=0.643, P=0.00) and CK-MB (r=0.828, P=0.00). 137 ACS were followed to one year. The heart rate, plasma creatinine, TLR4 protein, GRACE score, Gensini score, troponin, and creatine kinase isozyme were significantly higher in the endpoints group than in non-endpoints group. The prognostic criteria for TLR4 protein level determined by ROC was 35.48 (AUC, 0.83) (95%CI: 0.758～0.902,P=0.00). For GRACE score, the cut-off point was 124.5 (AUC, 0.753) ( 95%CI: 0.673～0.833, P=0.00). In the logistic regression model, both TLR4 protein and GRACE score were independent predictors of endpoints in patients with ACS. Both parameters were highly significant.Conclusion: TLR4 protein expression of peripheral blood monocytes is significantly higher in ACS patients than healthy people and stable angina patients. In the acute phase of ACS patients, TLR4 protein level show positive correlation with the GRACE score, Gensini score and myocardial enzymes (cTnI, CK-MB). Both TLR4 protein and GRACE score in the acute phase are independent predictors for endpoints in one year in patients with ACS.