急性心肌梗死患者介入治疗前后炎性细胞因子和MMP-9、CD40L变化及与预后的相关性

Changes in inlammutory cgtokins,MIP-9,and CD40L in acute myocardial infarction patients before and afte rpercutaneous coronary intervention and their correlation with prognosis

目的观察急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)前后炎性细胞因子及基质金属蛋白酶-9(MMP-9)、白细胞分化抗原CD40配体(CD40L)变化,分析其与预后的相关性。方法选择襄阳市中心医院2021年1月至2023年6月成功接受PCI的86例AMI患者作为研究对象,PCI前后检测血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、MMP-9、CRP、CD40L水平,所有患者均随访6个月,记录主要不良心血管事件(MACE)发生情况。根据PCI术后是否发生MACE及全因死亡分为预后良好组和预后不良组,比较两组IL-6、TNF-α等炎性细胞因子及MMP-9、CD40L水平,采用Pearson相关性分析PCI术后炎性细胞因子及MMP-9、CD40L水平与预后的相关性。结果86例AMI患者PCI术后24 h血清IL-6、TNF-α、MMP-9、CRP、CD40L水平均高于PCI术前,差异均有统计学意义(P<0.05)。AMI患者PCI术后均随访6个月,共31例患者发生MACE,为预后不良组,55例未发生MACE的患者为预后良好组。PCI术后24 h两组血清IL-6、TNF-α、CRP、MMP-9、CD40L水平均较术前明显升高;PCI术后24 h预后良好组血清IL-6、TNF-α、CRP、MMP-9、CD40L水平均低于预后不良组,差异均有统计学意义(P<0.05)。AMI患者MACE发生与血清IL-6、TNF-α、MMP-9、CRP、CD40L水平均呈正相关(r=0.529、0.471、0.402、0.367、0.394,均P<0.05)。IL-6、TNF-α、CRP、MMP-9、CD40L水平Cut-off值为58.31 pg/L、20.54 ng/mL、19.14 mg/L、77.62μg/L、6.95 ng/mL时AMI患者MACE发生的AUC分别为0.858、0.896、0.930、0.974、0.904;敏感度分别为88.19%、82.06%、83.94%、90.13%、87.22%;特异度分别为70.54%、74.47%、89.71%、91.46%、88.63%。结论PCI术可不同程度地激活局部和全身的炎症反应,增加动脉斑块的不稳定及血栓形成的概率。AMI患者PCI术后检测血清炎性细胞因子及MMP-9、CD40L水平对预测患者的近期预后有较高的临床价值。

Objective To observe changes in inflammatory cytokines,matrix metalloproteinase-9(MMP-9),and CD40 ligand(CD40L)in patients with acute myocardial infarction(AMI)before and after percutaneous coronary in-tervention(PCI)and analyze their correlation with prognosis.Methods Eighty-six AMI patients who underwent suc-cessful PCI at Xiangyang Central Hospital from January 2021 to June 2023 were selected.Serum levels of IL-6,TNF-α,MMP-9,CRP,and CD4OL were measured before and after PCI.All patients were followed up for six months,and major adverse cardiovascular events(MACE)were recorded.Based on the occurrence of MACE after PCI and all-cause mortality,patients were divided into the good prognosis group and poor prognosis group.The levels of inflammatory cyto-kines,MMP-9,and CD40L were compared between the two groups.Pearson correlation analysis was used to assess the correlation between inflammatory cytokines,MMP-9,CD40L levels,and prognosis after PCI.Results Twenty-four hours after PCI,serum levels of IL-6,TNF-α,MMP-9,CRP,and CD4OL in the AMI patients were higher than before PCI,and the differences were statistically significant(P<0.05).During the six-month follow-up,31 patients developed MACE,forming the poor prognosis group,while 55 patients without MACE constituted the good prognosis group.Twenty-four hours after PCI,both groups showed a significant increase in serum levels of IL-6,TNF-α,CRP,MMP-9,and CD40L compared to pre-PCI levels.The good prognosis group had lower serum levels of IL-6,TNF-α,CRP,MMP-9,and CD4OL than the poor prognosis group,and the differences were statistically significant(P<0.05).The occurrence of MACE in AMI patients was positively correlated with serum levels of IL-6,TNF-α,MMP-9,CRP,and CD40L(r=0.529,0.471,0.402,0.367,0.394,P<0.05).The AUCs for predicting MACE in AMI patients with IL-6,TNF-α,CRP,MMP-9,and CD40L were 0.858,0.896,0.930,0.974,and 0.904,respectively,with sensitivities of 88.19%,82.06%,83.94%,90.13%,and 87.22%,and specificities of 70.54%,74.47%,89.71%,91.46%,and 88.63%,respectively,using cut-off values.Conclusion PCI can activate local and systemic inflammatory responses to varying degrees,increasing the instability of atherosclerotic plaques and the likelihood of thrombus formation.Monitoring serum levels of inflammatory cytokines,MMP-9,and CD4OL after PCI in AMI patients has high clinical value for predicting short-term prognosis.