急性心肌梗死患者应用粒-巨噬细胞集落刺激因子后血CD34^+细胞和炎性因子的变化

Changes of the peripheral CD34 positive cells and inflammatory factors levels after using GM-CSF in patients with acute myocardial infarction

目的观察急性心肌梗死患者应用粒-巨噬细胞集落刺激因子(GM-CSF)后,外周血CD34+细胞的变化,探讨GM-CSF对炎性因子的影响。方法20例急性心肌梗死患者被随机分为GM-CSF[10μg/(kg.d),共7 d]组和对照组(生理盐水)。应用流式细胞仪检测患者外周血CD34+细胞的绝对计数。应用酶联免疫法及放射免疫法检测两组患者及10例健康者血C-反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的水平。结果与对照组相比,GM-CSF组在应用GM-CSF后外周血CD34+细胞数明显增高,于第7天达到高峰(P<0.05);心肌梗死患者血CRP、IL-6及TNF-α水平均明显高于健康者(P<0.05);GM-CSF组与对照组相比,CRP水平从第3天时开始升高,第10天时较对照组有明显的差别(P<0.05);两心梗组在IL-6及TNF-α水平上均无统计学意义的差别。结论GM-CSF可有效的动员急性心肌梗死患者外周血CD34+细胞,亦可增加CRP的水平。

Objective To investigate the changes of the peripheral CD34 positive cells in patients with acute myocardial infarction （AMI） after using granulocyte-macrophage colony-stimulating factor （GM-CSF） and to discuss the effects of GM-CSF on inflammatory factors. Methods Twenty patients with AMI were randomly divided into GM-CSF group （10μg/kg body weight, for seven days） and control group （saline）. The absolute counts of CD34 positive cells in peripheral blood were enumerated with flow cytometry. Plasma levels of C-reactive protein （CRP）, interleukin-6 （IL-6）, and tumor necrotic factor- α （TNF- α） were measured with enzyme-linked immunoassay and radioimmunoassay. Results Peripheral CD34 positive cells increased shortly after using GM-CSF and peaked on day 7 compared with those of controls （P〈0.05）. The levels of the CRP, IL-6 and TNF- α in patients with AMI were significantly greater than those in the healthy （P〈0. 05）. The plasma levels of CRP in GM-CSF group inclined to increase from day 3, but only on day 10 GM-CSF group had significantly higher levels of plasma CRP than controls （P〈0. 05）. The levels of IL-6 and TNF- α in the treated patients were the same as those in controls. Conclusion GM-CSF can effectively mobilize the CD34 positive cells and may increase the level of plasma CRP in patients with AMI.