急性心肌梗死患者免疫指标变化及其与心功能及心肌损伤的关系

Changes of immune indicators in patients with acute myocardial infarction and their relationship with cardiac function and myocardial injury

目的探究急性心肌梗死(AMI)患者免疫指标变化及其与心功能及心肌损伤的关系。方法选择郑州市第七人民医院收治的90例AMI患者为病例组,同期40名健康体检者作为对照组。比较两组免疫指标T淋巴细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+))、免疫球蛋白(IgA、IgG、IgM)及补体C3、C4水平,心功能指标[左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]及心肌损伤标志物[N末端B型利钠肽原(NTproBNP)、肌酸激酶(CK-MB)、心肌肌钙蛋白I(cTnI)]水平,分析病例组患者免疫指标与心功能指标、心肌损伤标志物的相关性。结果病例组CD3^(+)、CD4^(+)、CD8^(+)低于对照组,CD4^(+)/CD8^(+)、IgA、IgG、补体C3和C4水平高于对照组(P<0.05),差异均有统计学意义(P<0.05);病例组IgM水平与对照组比较差异无统计学意义(P>0.05);病例组LVEDV、LVEDD、NT-proBNP、CK-MB、cTnI水平高于对照组,LVEF低于对照组,差异均有统计学意义(P<0.05)。Pearson相关性分析显示,AMI患者CD4^(+)/CD8^(+)、IgA、IgG与LVEF呈负相关(r=-0.262、-0.302、-0.281,P均<0.05),与NT-proBNP(r=0.265、0.573、0.638,P均<0.05)、CK-MB(r=0.472、0.308、0.322,P均<0.05)、cTnI(r=0.339、0.348、0.372,P均<0.05)呈正相关;补体C3、C4与NT-proBNP(r=0.582、0.629,P均<0.05)、CK-MB(r=0.312、0.296,P均<0.05)、cTnI(r=0.384、0.217,P均<0.05)呈正相关。结论AMI患者发病后免疫指标存在异常变化,CD4^(+)/CD8^(+)、IgA、IgG与LVEF负相关,CD4^(+)/CD8^(+)、IgA、IgG、补体C3和C4与NT-proBNP、CK-MB、cTnI正相关,免疫指标可为AMI病情评估提供参考。

Objective To explore the changes of immune indicators in patients with acute myocardial infarction(AMI)and their relationship with cardiac function and myocardial injury.Methods 90 patients with AMI(case group)and 40 subjects with physical examination(control group)were selected in the Zhengzhou Seventh People’s Hospital.The levels of immune indicators of T lymphocyte subset indexes(CD3^(+),CD4^(+),CD8^(+)),immunoglobulins(IgA,IgG,IgM)and complements C3 and C4 were detected,and the cardiac function indicators[left ventricular end diastolic volume(LVEDV),left ventricular end diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)]and markers of myocardial injury[N-terminal pro-B-type natriuretic peptide(NT-proBNP),creatine kinase-MB(CK-MB),cardiac troponin I(cTnI)]were detected among two groups,to analyzed the correlation between immune indicators,cardiac function indicators and myocardial injury markers in the case group.Results The levels of CD3^(+),CD4^(+)and CD8^(+)in case group were significantly lower than those in control group while the levels of CD4^(+)/CD8+,IgA,IgG and complements C3 and C4 were significantly higher than those in control group(P<0.05).There was no significant difference in IgM level between case group and control group(P>0.05).The LVEDV,LVEDD and levels of NT-proBNP,CK-MB and cTnI in case group were higher than those in control group while the LVEF was lower than that in control group(P<0.05).Pearson correlation analysis showed CD4^(+)/CD8^(+),IgA and IgG of patients with AMI were negatively correlated with LVEF(r=-0.262,-0.302,-0.281,all P<0.05),and were positively correlated with NT-proBNP(r=0.265,0.573,0.638,all P<0.05),CK-MB(r=0.472,0.308,0.322,all P<0.05)and cTnI(r=0.339,0.348,0.372,all P<0.05).Complements C3 and C4 were positively correlated with NT-proBNP(r=0.582,0.629,all P<0.05),CK-MB(r=0.312,0.296,all P<0.05)and cTnI(r=0.384,0.217,all P<0.05).Conclusions After the onset of AMI,there were abnormal changes in immune indicators.CD4^(+)/CD8^(+),IgA and IgG were negatively correlated with LVEF,and CD4^(+)/CD8^(+),IgA,IgG and complements C3 and C4 were positively correlated with NTproBNP,CK-MB and cTnI,and immune indicators could provide reference for disease evaluation of AMI.