急性心梗患者介入前后血清炎性细胞因子水平变化与早期预后关系

摘要

目的：测定急性心肌梗死（AMI）患者行经皮冠状动脉介入（PCI）治疗前后相关炎性细胞因子的血清水平，了解其变化规律及临床意义。方法成功接受 PCI 的初发 AMI患者118例（治疗组，血样采集于 PCI 术前、术后12、24、48 h及随访期90 d）和仅接受诊断性冠脉造影（CAG）急性心肌梗死患者52例（对照组，血样采集于造影前、造影后12、24、48 h 及随访期90 d），检测血清白细胞介素6（IL-6）、白细胞介素18（IL-18）、高敏 C 反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）以及基质金属蛋白酶-9（MMP-9）水平，并随访 PCI组主要心脏不良事件（MACE）发生率。结果对照组和治疗组之间的 IL-6、IL-18、hs-CRP、TNF-α、MMP-9基础水平差异无统计学意义（P ＞0．05）；对照组冠脉造影前后血清 IL-6、IL-18、hs-CRP、TNF-α、MMP-9变化差异无统计学意义（P＞0．05）；治疗组术后 IL-6、IL-18、hs-CRP、TNF-α均较治疗前有显著升高（P ＜0．01）；治疗组术后血清 MMP-9较治疗前变化差异无统计学意义（P ＞0．05）；治疗组中，MACE 组与无MACE 组比较，IL-6、IL-18、hs-CRP 及 TNF-α水平差异均有统计学意义。结论 AMI 患者 PCI 术后血清 IL-6、IL-18、hs-CRP 和 TNF-α水平短期内显著增高，PCI 操作可能诱发炎性反应；外周血炎症因子 IL-6、IL-18、hs-CRP、TNF-α高水平可能对初发 AMI 患者 PCI 术后可能发生的 MACE 及近期预后有重要的参考价值。%Objective To investigate the variation and clinical significance of serum levels of inflammatory cyto-kines after percutaneous coronary intervention (PCI)treatment in acute myocardial infarction (AMI)patients. Methods 118 incipient AMI patients with successful underwent PCI (Defined as treatment group,blood samples were collected from pre-operation,12 h after operation,24 h after operation,48 h after operation and 90 d postop-erative follow-up period)and 52 AMI patients with diagnostic coronary angiography (CAG)(Defined as control group,blood samples were collected prior to CAG,12 h after CAG,24 h after CAG,48 h after CAG and 90 d fol-low-up period)were enrolled in this study.Serum levels of IL-6,IL-18,hs-CRP,TNF-αand MMP-9 were detec-ted in all the subjects by enzyme-linked immune sorbent assay(ELISA)and major adverse cardiac events(MACE) occurrence rate was analyzed in 90 days followed-up cases.Results No significant differences in baseline levels of IL-6,IL-18,hs-CRP,TNF-αand MMP-9 were found in the two study groups(P >0.05).No significant differences of levels of IL-6,IL-18,hs-CRP,TNF-αand MMP-9 were found after CAG in control group (P >0.05).The serum levels of IL-6,IL-18,hs-CRP and TNF-αafter PCI were significantly increased (P 0.05)in PCI group.There were significant differences of levels of IL-6,IL-18,hs-CRP and TNF-αbetween MACE group and without MACE group after PCI.The multivariable lo-gistic analysis showed that IL-6,IL-18,hs-CRP and TNF-αwere risk factors of MACE after 90 days follow-up. Conclusion The concentrations of serum IL-6,IL-18,hs-CRP and TNF-αare significantly increased in AMI pa-tients treated with PCI.PCI operation may induce inflammatory reaction.High serum levels of peripheral inflamma-tory cytokines IL-6,IL-18,hs-CRP and TNF-αhave an important role in major adverse cardiac events(MACE)and short-term prognosis in the first AMI patients treated with successful primary PCI.