缬沙坦对心肌梗死后室性心律失常患者肿瘤坏死因子α和超敏C-反应蛋白的影响

Effect of valsartan on TNF-α,HCRP in the patients with ventricular arrhythmia after myocardial infarction

目的观察急性心肌梗死(AMI)后1个月内肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(HCRP)的动态变化,及缬沙坦对两者的影响,并结合心肌梗死(MI)后室性心律失常(VAR)发生情况进行分析。方法对150例广泛性前壁MI患者进行追踪式观察,在最初24h内随机均分为两组:MI组、缬沙坦组,同时建立对照组(n=30)。第1、14、30天时对患者血清中TNF-α、HCRP水平进行测定;30d后行Holter检查,对VAR发生情况进行统计。结果第1天时MI组和缬沙坦组与对照组比较均有较高的TNF-α和白细胞水平(P＜0．01,P＜0．05),但在两组间差异无统计学意义;第14天时TNF-α水平在MI组和缬沙坦组间比较差异有统计学意义(P＜0．01);第30天时MI组的TNF-α水平仍要比缬沙坦组高(P＜0．05),TNF-α水平在缬沙坦组与对照组间比较差异无统计学意义。MI组和缬沙坦组的HCRP水平仅在MI后第1天较对照组显著升高(P＜0．01)。30d后与MI组相比,缬沙坦组VAR发生率明显降低(P＜0．05)。直线相关分析示,MI组和缬沙坦组TNF-α水平与VAR发生呈正相关(P＜0．01,P＜0．05)。结论①血清中TNF-α变化对MI后VAR的发生有一定的影响。②缬沙坦或许可以通过减少血清中TNF-α水平而降低MI后VAR的发生率。

Objective To study the variations of tumor necrosis factor - α （TNF - α ） and high sensitivity C -reactive protein （HCRP） after acute myocardial infarction （AMI） at different times, and to investigate the effect of valsartan on the levels of TNF - α and HCRP and the occurrence of ventricular arrhythmia. Method 150 patients with extensive anterior wall infarction were classified randomly into two groups： MI group, valsartan group, at the same time 30 patients with coronary heart diseases excluding MI were enrolled continuously in control group. Serum TNF - α and HCRP levels were measured respectively on 1st, 14th and 30th day. After 30 days, electrocardiogram monitoring was used in the three groups. Results On the 1st day, the levels of TNF -α and leucocyte in the MI and valsartan groups were higher than those in the control group （P 〈0. 01, P 〈0.05}, but there were no differences between two groups; on the 14th day, the level of TNF - α was significantly different between the MI group and valsartan group （ P 〈 0. 05 ）. On the 30th day, the TNF - α level in the MI group was higher than that in the valsartan group （ P 〈 0. 05 ）, but no significant difference was observed between the control group and valsartan group （ P 〉 0. 05 ）. However, HCRP was different among the three groups only on the first day （ P 〈 0.01 ）. After 30 days, ventricular arrhythmia occurrence in the valsartan group was significantly lower in comparison with that in the MI group （ P 〈 0.05 ）. Via the linear correlation analysis in the MI group and valsartan group, positive relationship was fount between TNF - α level and ventricular arrhythmia occurrence （ P 〈 0. 01, P 〈 0.05 ）. Conclusion Seram TNF - α level has influence on ventricular arrhythrmia after MI. It indicates that valsartan may decrease the occurrence of ventricular arrhythmia by reducing TNF - α in the serum.