梗死前心绞痛诱发的免疫炎症反应对心肌保护作用的临床研究

Clinic study of myocardium protective effect of immunoinflammatory response induced by preinfarction angina

目的通过对有无梗死前心绞痛的急性心肌梗死患者免疫标志物的测定,研究梗死前心绞痛诱发的免疫炎症反应对心肌的保护作用。方法观察梗死前心绞痛组(48例)和无梗死前心绞痛组(40例)在住院期间严重心律失常、心功能不全、心源性休克的发生情况及住院期间的病死率;比较两组心肌梗死面积、心室功能、冠状动脉造影结果;测定两组免疫炎症反应标志物水平。结果梗死前心绞痛组严重心律失常发生率、心功能不全发生率、住院期间病死率明显低于无梗死前心绞痛组;梗死前心绞痛组肌酸激酶(CK)、肌酸激酶同工酶MB(CK-MB)、左室收缩末容量(LVESV)、左室舒张末容量(LVEDV)明显低于无梗死前心绞痛组,左室射血分数(LVEF)高于无梗死前心绞痛组;冠状动脉造影显示梗死前心绞痛组冠状动脉多支病变多,梗死区周围侧支循环丰富;梗死前心绞痛组白细胞计数、C-反应蛋白明显低于无梗死前心绞痛组,IgE明显高于无梗死前心绞痛组。结论梗死前心绞痛诱发的免疫炎症反应对心肌有保护作用。

Objective To investigate the myocardium protective effect of immunoinflammatory response induced by preinfarction angina. Methods Eighty - eight patients of acute myocardial infarction were divided into preinfarction angina group （48 subjects） and sudden onset group （40 subjects）. The incidence of severe arrhythraia, heart failure, cardiac shock and in - hospital mortality were assessed in the two groups. The myocardial infarction size, ventricular function, coronary angiography were compared between the two groups. Some immunoinflammatory markers levels were detected. Results In preinfarction angina group, the incidences of severe arrhythmia, heart failure, and in - hospital mortality were lower （P 〈 0.05 ）, the LVEF was higher, the peak of value CK, CK - MB, LVESV and LVEDV were lower （ P 〈0.05 ）. The rates of maltivessel diseases and collateral circulation were much more（ P 〈 0.05）. White blood cell count and C - reactive protein（CRP） were significantly lower （ P 〈0.05）. Conversely, IgE was significantly higher （ P 〈 0.05 ）. Conclusion It is suggested that the immunoinflammatory response induced by preinfarction angina have a myecardium protective effect.