急性心肌梗死患者血浆可溶性P选择素等因子的动态变化及早期再灌注治疗对其影响

Changes of plasma soluble P-selectin, TNF-α and IL-6 in patients with acute myocardial infarction and effects of early reperfusion therapy on them

目的:观察急性心肌梗死(AMI)患者血浆可溶性P选择素(sP选择素)、肿瘤坏死因子α(TNFα)和白细胞介素6(IL6)的动态变化及早期再灌注治疗对其影响。方法:ELISA法测定26例AMI患者发作6、12、24、48、72h时的血浆sP选择素、TNFα及IL6的浓度,26例患者均在入院时进行抗栓及成功实施了急诊再灌注治疗。经冠状动脉造影证实的稳定型心绞痛(SAP)患者21例及冠状动脉造影正常者20例作为对照。结果:①AMI患者发病6h内sP选择素的浓度[(177.6±20.1)μg/L]显著高于SAP组[(75.4±6.8)μg/L]和正常对照组[(67.9±7.7)μg/L,P<0.01];12h时sP选择素浓度进一步升高[(226.2±33.6)μg/L,P<0.01];24h时sP选择素明显下降[(102.2±13.5)μg/L],但仍高于SAP组和正常对照组(P<0.05);48、72时,sP选择素浓度与正常对照组比较无统计学差异。②AMI患者发病6hTNFα与IL6即升高,24h达高峰,72h后仍高于正常。③直线相关分析提示,AMI患者发病6h的sP选择素与TNFα、IL6水平呈正相关(r=0.74,P<0.01;r=0.68,P<0.01)。结论:AMI发生6h时sP选择素水平明显升高,早期成功再灌注治疗使sP选择素很快达峰值,然后迅速下降,但对TNFα和IL6无明显抑制作用。

Obiective:To observe changes of plasma soluble P-selectin, TNF-α and IL-6 in patientswith acute myocardial infarction (AMI) and effects of early reperfusion therapy on them. Method:The plasma sP-selectin, TNF-α and IL-6 were measured at the time of 6, 12, 24, 48, 72 hours afterAMI onset in 26 patients admitted within 6 hours after symptom onset. All patients were given antithrombus and successful reperfusion therapy at the time of admission . And the concentration of those in 21 patients with stable angina pectoris and 20 normal controls demonstrated by coronary angiography were also measured. Result:①The level of sP-selectin was higher significantly within 6 hours of symptom onset in patients with AMI than those in patients with stable angina and controls [ (177.6±20.1)μg/L vs (75.4±6.8) μg/L vs (67.9±7.7) μg/L , P< 0.01]. The levels of sP-selectin reached their peak after 12 hours of symptoms onset (4 hours after reperfusion therapy successfully) in patients with AMI [(226.2±33.6) μg/L ,P< 0.01], and decreased significantly at 24 hours of symptoms onset, but still higher than that in controls (P< 0.05). There was no difference between the levels of sP-selectin at 48 and 72 hours of symptoms onset in AMI patients and those in controls. ②The TNF-α and IL-6 increased at 6 hours, climaxed at 24 hours, and were still high at 72 hours after the symptoms onset in patients with AMI. ③The levels of sP-selectin was correlated significantly with those of TNF-α and IL-6 at 6 hours of symptoms onset in AMI patients (r=0.74,P< 0.01;r=0.68,P< 0.01). Conclusion:sP-selectin increase significantly after 6 hours of symptoms onset in patients with AMI. Levels of sP-selectin reach their peak soon after early antithrombus and reperfusion therapy and decreaes significantly at 24 hours of AMI onset. But early reperfusion therapy do not affect TNF-α and IL-6.