急性心肌梗死合并多器官功能障碍综合征患者血清免疫球蛋白、补体和C-反应蛋白的变化

Change in Serum Immunoglobulin, Complements and C-reactive Protein in Acute Myocardial Infarction Patients with Multiple Organ Dysfunction Syndrome

目的:探讨急性心肌梗死(AMI)合并多器官功能障碍综合征(MODS)患者免疫功能的变化及临床意义。方法:81例AMI患者分为AMI(A)组及AMI合并MODS(B)组,分别在病后第1、7及14 d测定免疫球蛋白IgG、IgA、IgM,补体C3、C4及C-反应蛋白(CRP),并与正常对照组进行对比分析。再根据溶栓情况将81例AMI患者分为常规治疗组、溶栓未通组、溶栓再通组,溶栓后2 h再测定上述指标。结果:两组免疫球蛋白、补体均在病后第1 d明显降低,而CRP明显升高(P<0.05)。A组在病后第7 d免疫球蛋白、补体及CRP均基本恢复正常(P>0.05);而B组在病后第7 d IgG、IgA仍明显低于正常,而CRP更为升高(P<0.01),A组在病后第14 d免疫球蛋白及补体均明显高于正常(P<0.01),而B组免疫球蛋白稍高于正常;CRP下降至接近正常。溶栓再通组免疫球蛋白、补体均明显高于溶栓未通组和常规治疗组:溶栓再通组CRP明显低于溶栓未通组和常规治疗组。结论:AMI后早期免疫功能处于抑制状态,动态观察免疫球蛋白、补体及CRP在血清中的变化可作为AMI患者病情观察的客观指标。

Objective: To investigate the clinical significance of change in immune functions in acute myocardial infarction (AMI) patients with multiple organ dysfunction syndrome(MODS). Methods: 81 cases were divided into AMI (A) group and AMI with MODS (B) group. IgG, IgA, IgM, complement 3 (C3), complement 4 (C4) and C-reactive protein (CRP) were determined on day 1,7 and 14 after the onset. 81cases were divided into three groups: conventional treatment group, non-reperfusion group and reperfusion group. IgG, IgA, IgM, C3, C4 and CRP were determined after thrombolysis at 2 hs. Results: IgG, IgA, IgM, C3, and C4 decreased whereas CRP markedly increased in both A and B group on day 1 after the onset (P<0.05), IgG, IgA, IgM, C3, and C4 returned to normal and CRP tended to approach normal values in A group on day 7 after the onset (P>0.05). However, IgG, IgA, IgM, C3, and C4 were still significantly lower whereas CRP was even much higher in B group on day 7 after the onset (P<0.01). IgG,IgA,IgM,C3,and C4 were increased in A group (P<0.01). IgG,IgA,IgM,C3,and C4 were slightly higher in B group on day 14 after the onset. IgG, IgA,IgM,C3,and C4 were significantly higher in the reperfusion group after thrombolysis than in other groups (P<0.05). CRP were significantly lower in the reperfusion group after thrombolysis than in other groups (P<0.01). Conclusions: It suggests that immune function was suppressed during early phase after AMI. The kinetic change in IgG, IgA, IgM, C3, C4 and CRP might be used as parameters to evaluate the general state of AMI.