冠心病与炎症及免疫学因素关系的临床研究

The clinical research of relation of CAD and inflammation and immune system activation

目的:通过将炎症及免疫系统激活与冠心病的临床演变过程相结合,探讨炎症及免疫学因素在冠心病发生及发展中的作用.方法:将研究对象分5组,急性心肌梗死组(Ⅰ组,21例),不稳定型心绞痛患者共39例,分为对药物治疗敏感组(Ⅱ组,19例)和顽固性心绞痛组(Ⅲ组,20例),稳定型心绞痛组(Ⅳ组,18例)及行PTCA术治疗组(Ⅴ组,19例).标本为两次清晨外周静脉血,标本1在患者入院次日采集,标本2在取标本1后7～15日内采集.观察指标有IgG、IgA、IgM、IgE、CRP、C3、C4、CD3、CD4、CD8、CD4/CD8等.结果:不稳定型心绞痛组的血浆CRP浓度明显高于稳定型心绞痛组(P＜0.01),Ⅲ组的血浆CRP浓度明显高于Ⅱ组(P＜0.01),Ⅱ组的IgM水平标本2较标本1显著增高(P＜0.01),而Ⅰ、Ⅲ、Ⅳ、Ⅴ组的血浆CRP、IgM水平在观察期间其组间及组内相比较均无明显变化(P＞0.05).结论:1.不稳定型心绞痛的本质可能是抗原介导的免疫反应;2.PTCA术本身有导致炎症反应的趋势,CRP对术后患者的预后估计有重要价值.

Objective： To assess the relations between inflammation, specific immune response and clinical course in unstable angina（UA）and the reason why serum CRP level increased after percutaneous transluminal coronay angioplasty （PTCA）. Methods： We compared serum levels of Creactive protein（CRP） （inflammation）, IgG, IgM, IgA, IgE, Ca, C4 （ humoral immunity）, and t he percentage of CD4^＋ , CD8^＋ and CD4^＋/CD8^＋ （cell mediated immunlty）in 21 patients with AMI, 39 patients with UA, 19 patients with chronic stable angina（CSA） and 19 patients who recepted elective PTCA during a period of about 15 days. Results; The CRP levels were higher in unstable angina than in stable angina. In UA, the serum levels of IgM significantly increased at 7 to 15 days. The percentage of CD4, CD8 and CD4/CD8 have no change during the study period. The increasement of the serum level of IgM was associated with the better outcome. IgG, IgA,IgE, Cs ,C4 ,CD3 ,CD4, CD8 and CD4/CD8 did not show any further variation during the study period in other groups. Conclusions： The inflammatory component systemically detectable in UA may be antigen-related and that the magnitude of the immune response correlates with the clinical outcome of instability. Moreover, PTCA triggers a systemic inflammatory response characteriaed by an elevation in CRP levels and CRP may offer prognostic information after elective PTCA and identify a subgroup of patients at high risk for clinical restenosis.