冠心病患者冠状动脉药物洗脱支架植入前后高敏C反应蛋白和白细胞介素6的变化

Changes of Plasma High-sensitivity C-reactive Protein and Interleukin-6 After Coronary Stent Implantation

目的通过比较冠心病患者冠状动脉药物洗脱支架植入前后血浆高敏C反应蛋白(hs-CRP)和白细胞介素6(IL-6)水平的变化,判断药物洗脱支架时代冠心病患者介入治疗前后炎症状态的变化。方法连续入选从2013年10月28日至2014年2月5日在北京大学第一医院心内科就诊并行介入治疗的冠心病患者,签署知情同意书,收集其临床资料和介入手术情况,采集介入治疗前、介入治疗后1天及3天的血样标本,测定hs-CRP和IL-6浓度,比较介入治疗前后上述指标的变化情况,并分析这些变化与冠心病分型和Syntax评分之间的关系。结果共入选资料完整的冠心病患者130例。介入治疗后1天血浆IL-6水平较术前明显升高(65.71±34.23 ng/L比56.76±34.08 ng/L,P<0.001),介入治疗后3天hs-CRP水平较术前明显升高(8.12±10.18 mg/L比4.03±5.06 mg/L,P<0.001);术后1天hs-CRP(P=0.002)、术后3天hs-CRP(P=0.016)与冠心病分型相关,在稳定型心绞痛患者中最低,在不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死患者中依次升高;Syntax评分高者术后1天hs-CRP水平高于Syntax评分低者(7.64±9.82 mg/L比3.60±4.80 mg/L,P=0.005),Syntax评分高者术后3天hs-CRP水平也高于Syntax评分低者(11.13±10.49 mg/L比5.49±9.20 mg/L,P=0.002);术后hs-CRP与Syntax评分存在正向相关关系。结论冠心病患者介入治疗后机体产生快速而强烈的炎症反应,这种反应通过IL-6、hs-CRP的浓度变化得到反映,且无法被涂层药物完全抑制。急性冠状动脉综合征患者介入治疗后炎症反应较稳定型心绞痛患者更为强烈。冠状动脉Syntax评分高的患者介入治疗后炎症反应更强。

Background In-stent restenosis( ISR) and stent thrombosis( ST) have limited the efficacy of percutaneous coronary intervention( PCI). Besides technical factors,the inflammatory status of an individual is a strong predictor of the risk of ISR and ST after implantation of drug-eluting stents,the value of these biomarkers remains to be evaluated. Aim We tried to evaluate the change of different inflammatory biomarkers after DES implantation. Methods We selected 130 coronary heart disease( CHD) patients who were implanted DES. The high-sensitivity C-reactive protein( hs-CRP) and interleukin-6( IL-6) were measured before,1 day and 3 days after the procedure. Changes of these biomarkers were observed and the relationship with types of CHD and Syntax score were also evaluated. Results The hsCRP increased significantly at 3 days after PCI compared with baseline( 8. 12 ± 10. 18 mg / L vs. 4. 03 ± 5. 06 mg / L,P <0. 001) and there was a significant increase in the IL-6 level at 1 day after PCI( 65. 71 ± 34. 23 ng / L vs. 56. 76 ± 34. 08 ng / L,P < 0. 001). The level of hs-CRP 1 day( P = 0. 002) and 3 days( P = 0. 016) after PCI differs between different CHD types,which increased from stable angina pectoris( SAP) to acute coronary syndrome( ACS). Patients with higher Syntax score got a higher level of hs-CRP at 1 day( 7. 64 ± 9. 82 mg / L vs. 3. 60 ± 4. 80 mg / L,P = 0. 005) and 3 days( 11. 13 ± 10. 49 vs 5. 49 ± 9. 20 mg/L,P = 0. 002) after PCI. The hs-CRP level at 1 day after PCI was positively correlated with the Syntax score( r = 0. 247,P = 0. 005). Conclusions The procedure of PCI in CHD patients will activate acute inflammatory reaction,which can be measured with the change of hs-CRP and IL-6 levels in plasma. The inflammation in ACS patients is stronger than that in SAP patients. Patients with higher Syntax score get higher inflammatory reaction after PCI.