急性心肌梗死急诊介入治疗对炎性细胞因子影响的研究

The influence of emergency percutaneous coronary intervention on plasma cytokines in acute myocardial infarction

目的观察急性心肌梗死(AMI)患者的梗死相关血管开通前后致炎细胞因子白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)和抗炎细胞因子白细胞介素-10(IL-10)的动态变化。方法采用酶联免疫吸附法测定8例健康人(健康对照组)和22例AMI患者急诊经皮冠状动脉介入治疗(急诊PCI组)术前即刻、术后12、24 h,血浆IL-1βI、L-6、IL-10的变化,比较致炎细胞因子IL-1βI、L-6和抗炎细胞因子IL-10的变化幅度。结果再灌注前急诊PCI组患者血浆IL-10略高于健康对照组,但无统计学差异(P>0.05),IL-1βI、L-6却显著高于健康对照组[(27.98±8.76)ng/Lvs(20.44±11.32)ng/L,P<0.05;(31.89±6.89)ng/Lvs(15.55±3.81)ng/L,P<0.05];再灌注后122、4 h急诊PCI组患者血浆IL-1βI、L-6及IL-10均较术前显著增高(P<0.01,P<0.01,P<0.05)。急诊PCI组患者再灌注治疗后12 h抗炎细胞因子IL-10的升高幅度显著低于致炎细胞因子IL-1βI、L-6的升幅(P<0.01)。结论心肌缺血再灌注后致炎细胞因子较抗炎细胞因子增高更显著。

Objective To observe the dynamic changes of interleukin-1β,interleukin-6 and interleukin-10 in AMI patients before and after recanalization of infarct-related artery （IRA）. Methods In 22 AMI patients and 8 healthy men,plasma IL-1β,IL-6 and IL-10 were measured by ELISA before emergency PCI, 12 h and 24 h post-intervention. Amplitudes of changes in plasma IL-1β, IL-6 and IL-10 were compared. Refits Plasma IL-10 in AMI was not significantly higher than that in healthy controls（ P 〉0.05） before emergency PCI,but IL-1β and HAS were significantly higher[（27.98±8.76） ng/L vs （20.44±11.32）ng/L, P 〈 0.05; （31.89±6.89） ng/L vs （15.55 ±3.81） ng/L, P 〈 0.05] .Plasma IL-1β,IL-6 and IL-10 at 12 h and 24 h post-intervention were significantly higher than those before PCI（ P 〈0.01, P 〈0.01, P 〈0.05）. In patients with successful PCI and having TIMI grade-3 flow in IRA,the amplitude of IL-10 increase was significanfly less than that of IL-1β and IL-6 （ P 〈0.01）.Conclusions IL-1β, IL-6 and IL-10 may be involved in myocardial ischemia-reperfusion injury. The imbalance between inflammation-promoting and anti-inflammatory cytokines may be one of the mechanisms resulting in myocardial ischemia-reperfusion injury.