Objective To study the serum level changes in Toll-like receptor 2,4 and soluble ST2 in the circulation in elderly patients with old myocardial infarction and the clinical significance.Methods A total of 140 patients with old myocardial infarction combined with chronic left-sided heart failure from Jan.2010 to Mar.2014,and 50 controls were selected.Serum level changes in TLR2 and TLR4 were detected by flow cytometry and compared with hs-CRP.The levels of hs-CRP and sST2 were tested by nephelometry immunoassay and enzyme-linked immunosorbent assay (ELISA) respectively.Results The levels of hs-CRP,TLR2,TLR4 and sST2 were elevated along with the severity of old myocardial infarction in elderly patients.The levels of hs-CRP,TLR2,TLR4 and sST2 were lower in patients with single vessel disease than in patients with four-vessel disease [hs-CRP:(1.9±0.9) mg/L vs.(14.9± 1.9) mg/L,TLR2:(7.5±0.9) MFI vs.(15.1± 1.8) MFI,TLR4:(5.5±0.8) MFI vs.(11.8±7.1) MFI,sST2:(22.6±0.4)μg/L vs.(28.7±0.9)μg/L,all P＜ 0.01].Levels of hs-CRP,TLR2,TLR4 and sST2 were lower in patients with NYHA Ⅰ than in patients with NYHA Ⅳ [hs-CRP:(1.9±0.2) mg/L vs.(15.0±1.9) mg/L,TLR2:(7.3±0.2)MFI vs.(16.7±2.9)MFI,TLR4:(5.8±0.9) MFI vs.(17.9±6.9) MFI,sST2:(22.4±0.6) μg/ L vs.(30.3± 1.0) μg/L,all P＜0.01].The levels of hs-CRP,TLR2,TLR4 and sST2 were gradually increased along with the increases of Canadian Cardiovascular Society Angina Pectoris Grade and cardiac function classification of the American College of Cardiology (all P＜0.01).Conclusions Serum level changes in hs-CRP,TLR2,TLR4 and sST2 in elderly patients with old myocardial infarction may become the new indicators to forecast the degree of old myocardial infarction.%目的 分析陈旧性心肌梗死老年患者外周血Toll样受体2(TLR2)、TLR4、超敏C-反应蛋白(hs-CRP)和可溶性ST2蛋白(sST2)的表达和临床意义. 方法 选择2010年1月至2014年3月老年陈旧性心肌梗死合并慢性左心衰竭患者140例,对照组50例.采用流式细胞术检测血清TLR2和TLR4水平的变化,并与hs-CRP进行对照分析.应用免疫散射比浊法测定hs-CRP的水平.采用双夹心抗体酶联免疫吸附法定量检测sST2. 结果 老年陈旧性心肌梗死患者,随着心肌梗死程度的加重,hs-CRP、TLR2、TLR4和sST2水平升高.冠状动脉单支与4支病变患者hs-CRP(1.9±0.9)mg/L比(14.9±1.9) mg/L、TLR2:(7.5±0.9)MFI比(15.1±1.8) MFI、TLR4:(5.5±0.8) MFI比(11.8±7.1)MFI、sST2:(22.6±0.4)ng/ml比(28.7±0.9)ng/ml(均P＜0.01);NYHAⅠ级组与NYHAⅣ级组hs-CRP (1.9±0.2)mg/L比(15.0±1.9)mg/L、TLR2:(7.3±0.2)MFI比(16.7±2.9) MFI、TLR4:(5.8±0.9) MFI比(17.9±6.9) MFI、sST2:(22.4±0.6) μg/L比(30.3±1.0)μg/L(均P＜0.01);随加拿大心血管病学会(CCS)心绞痛分级升高,hs-CRP、TLR2、TLR4和sST2水平增高;随着美国心脏病学会心功能分级增高,hs-CRP、TLR2、TLR4和sST2水平上升,各NYHA级别组间比较,差异有统计学意义(均P＜0.01). 结论 hs-CRP、TLR2、TLR4和sST2水平的变化可能影响老年人陈旧性心肌梗死的严重程度.
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