| Objective:This study by flow cytometry technique(flow cytometry FC)determination in patients with ACS in the peripheral blood T lymphocyte subsets CD4 + T cells,the percentage of CD8 + T cell levels,relationship of the preliminary discussion on the immune function in patients with ACS,impact on the occurrence and development of acute coronary syndrome(ACS),at the same time observation and reflection narrow degree Gensini score the correlation between coronary artery lesions.Finally,to explore the clinical significance.Methods:Collected the Patients from January 2018 to January 2019 who were admitted to the department of cardiology of our hospital,and after preoperative conversation agree to coronary angiography(oronary arteriography the CAG)for a total of 96 cases(male: 61 cases,female: 35 cases)patients were as the research object,the experimental group included 81 patients with coronary heart disease who were diagnosed with clinical symptoms,signs,electrocardiogram and angiography,according to the diagnostic standard of ACS in turn divided into stable angina(1 group,n = 21),unstable angina pectoris group or non ST segment elevation myocardial infarction(2 group,n = 37 cases),and st-elevation myocardial infarction(3 group,n = 23),at the same time by coronary angiography in the diagnosis of ACS and atypical chest pain,electrocardiogram(ecg)normal in 15 patients as control group(4 group,n=15),flow cytometry technology determined through four groups of patients with CD4 + T cells and CD8 + T cell percentage,analyzed the change of CD4+ T cells and CD8+T cells in 4 groups.Theseverity of coronary artery disease was assessed by Gensini score.With the Gensini score,96 patients were divided into two groups: non-severe stenosis and Severe stenosis.The basic clinical data of the ACS group and the control group were compared.At the same time,the ratio of CD4+ and CD8+ cells was compared with the Gensini score within the ACS group.Meanwhile,the correlation between the risk factors of coronary heart disease and ACS was analyzed.In the end,binomial Logistic regression was performed to analyze which was the independent risk factor of ACS.According to the results of Gensini score,the subjects were divided into Severe stenosis group(>40 points)and non-severe stenosis group(? 40 points).ROC curve analysis was used to obtain the optimal cut-off point value of CD4+/ CD8+ ratio for predicting the diagnosis of ACS before the onset.Provide clinical diagnostic value.Results:1.Comparison of clinical data between the four groupsThere was no significant difference in whether the patients in the four groups(NSTEACS,STEMI,SA and control group)had hypertension,type 2 diabetes,blood lipids,homocysteine and other CHD risk factors(P>0.05).However,there were statistically significant differences in age and gender between the NSTEACS group and the SA group and the control group(P < 0.05),while there were no significant differences in age between the STEMI group and the other three groups(P > 0.05),and there were statistically significant differences in gender between the STEMI group and the other three groups(P < 0.05).Hdl-c in the STEMI group was smaller than that in the other three groups,which was statistically different from that in the NSTEACS group and the control group(P < 0.05).In the ACS(STEMI and NSTEACS)group,the ApoA-1 value was lower than that in the SA group and the control group,and there were statistically significant differences(P < 0.05).The Gensin score of SA group was lower than that of STEMI group and NSTEACS group,and the Gensin score of NSTEACS group was lower than that of STEMI group,showing statistical difference(P < 0.05).2.Comparison of the percentage of T lymphocyte subsets in peripheral blood ofeach group(1)The percentage of CD3+ in the T-lymphocyte subsets in the peripheral blood of the patients in the four groups was higher than that in the control group(P<0.05).The percentage of CD3+ in the t-lymphocyte subsets in the STEAMI group was higher than NSTEACS group and SA group,and the expression rate was apparently higher than that of the control group(P<0.05).The expression percentage of CD3+ cells in peripheral blood of SA group was a little more higher than that of control group(P<0.05).(2)Percentage of CD4+ in CD3+ and CD4+ lymphocytes in peripheral blood: the percentage of CD4+ in CD3+ ? CD4+ lymphocytes in NSTEACS group and STEMI group was apparently higher than that in SA group and control group(P<0.05),and the percentage of CD4+ in CD3+?CD4+ lymphocytes in peripheral blood of SA group was significantly higher than that in control group(P<0.05).(3)Percentage of CD8+ in CD3+ and CD8+ lymphocytes in peripheral blood: the percentage of CD8+ in CD3+ ? CD8+lymphocytes in NSTEACS group and STEMI group was lower than that in SA group and control group(P<0.05),and the percentage of CD8+ in CD3+?CD8+ lymphocytes in peripheral blood of SA group was significantly lower than that in control group(P<0.05).(4)Percentage of CD4+ /CD8+ lymphocytes in peripheral blood: the ratio of CD4+ /CD8+ in peripheral blood of NSTEACS group,STEMI group and SA group was higher than that of control group(P<0.05),and the percentage of CD4+ /CD8+lymphocyte expression in peripheral blood of SA group was higher than that of control group(P<0.05).3.Comparison of Gensini scores among four groups of patientsThe Gensini scores of the STEMI and NSTEACS groups were higher than those of the SA and control groups(P < 0.05),and the STEMI scores were higher than those of the NSTEACS group(P < 0.05).There was no significant difference between the SA group and the control group(P > 0.05).4.The ratio of T lymphocytes in peripheral blood of ACS patients was correlated with Gensini score and other factors(1)Correlation analysis of the percentage of T subgroup lymphocytes in peripheral blood with Gensini score: statistical method spearman correlation analysis showed that Percentage of CD3+?CD4+ in CD3+ and CD4+lymphocytes in peripheral blood of the ACS group(STEMI group and NSTEACS group)was positively correlated with the degree of coronary artery stenosis(0.517,P<0.05).0.649,P < 0.05;0.661,P < 0.05);The percentage of CD8+ in CD3+ and CD8+ lymphocytes in the peripheral blood of the ACS group was negatively correlated with the Gensini score(-0.404,P<0.05).-0.351,P<0.05).In the ACS group,the percentage of CD4+ /CD8+ lymphocytes in peripheral blood was positively correlated with the degree of coronary artery stenosis(0.554,P<0.05).(2)Regression and correlation analysis of ACS patients and risk factors.In ACS patients,sex and age were positively correlated with ACS(P<0.05),apoa-1 was negatively correlated with ACS(P<0.05),while hdl-c,ldl-c,TC,TG,hypertension and diabetes were not correlated with ACS(P>0.05).Gender and age were independently correlated with ACS in binomial logistic regression analysis(P<0.05).5.Diagnostic value of peripheral blood T lymphocyte ratio in the prediction of lesion degree in ACS patients.ROC curve was used to analyze the diagnostic value of peripheral blood T lymphocyte ratio in the prediction of lesion degree in ACS patients.According to Gensini score,the patients were divided into two groups non-severe stenosis group(? 40 points)and severe stenosis group(>40 points),and the optimal cut-off point value was 2.04.The sensitivity,specificity and AUC of this cut-off point value in predicting the degree of coronary stenosis were 0.841,0.583 and 0.826(95%ci0.743-0.910,P=0.01).Conclusion:T cell subsets in peripheral blood actively participate in the occurrence and development of coronary heart disease,Weakened the stability of plaques,and lead to and catalyze the occurrence and development of acute coronary syndrome.Moreover,in ACS patients,age,gender,CD4+T lymphocytes,CD8+T lymphocytes,and CD4+/CD8+ratio may be independent predictors of the assessment.In the onset of disease,with the increase of the expression ratio of CD4+T lymphocytes,the degree of coronary artery deterioration is also aggravated.On the contrary,CD8+T lymphocytes may be a protective barrier blocking its deterioration.In the early stage of the disease,the increase of CD4+T lymphocytes can promote the inflammatory response in ACS patients,while the decrease of CD8+T lymphocytes leads to the decrease of the ability to remove toxic substances,and ultimately destroys the balance between inflammation and immunity.In addition,with the disruption of the immune balance,the ratio of CD4+/CD8+ may become a predictor of the degree of early coronary artery stenosis in ACS patients. |
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