冠状动脉支架置入后嗜中性粒细胞活化标志物的早期释放

Early release of neutrophil activation markers after direct coronary stenting

目的:通过测定不稳定心绞痛患者支架置入后早期血浆中髓过氧化物酶,乳铁转运蛋白的含量,对分叶核嗜中性粒细胞的活化进行评价。方法:2005-10/2007-06在中南大学湘雅二医院就诊的冠心病患者中选取215例不稳定心绞痛患者,Braunwald分级II级或III级。所有入选者均签署知情同意书。所有患者都行冠状动脉造影,对其中125例最严重罪犯血管行支架置入(支架置入组)治疗,另90例因严重多支病变将行外科血管搭桥或因经济原因放弃支架置入(非支架置入组)。所有患者均在不同时段采取血样直至支架置入后24h,测定其血清髓过氧化物酶、乳铁转运蛋白、C反应蛋白以及细胞因子水平。结果:215例患者均进入结果分析。①非支架置入组患者髓过氧化物酶、乳铁转运蛋白水平保持不变,支架置入组患者髓过氧化物酶、乳铁转运蛋白水平显著升高(P<0.01)。②非支架置入组患者不同时间所采血样中白细胞介素8和白细胞介素12水平没有变化,支架置入组患者中白细胞介素8和白细胞介素12有一过性升高,白细胞介素6在两组患者中都升高(P<0.05)。③两组患者C反应蛋白的基线值相同,且支架置入后均有显著升高,而支架置入组升高更明显(P<0.01)。结论:不稳定心绞痛患者支架置入与嗜中性粒细胞的快速活化密切相关,髓过氧化物酶是不稳定心绞痛患者冠状动脉支架置入后炎症反应的始动和促发因素。

AIM：To assess polymorphonuclear neutrophils activation after stenting in unstable angina by myeloperoxidase and lactoferrin release. METHODS： 215 patients with unstable angina, stage Ⅱ or Ⅲ by Braunwald, were selected from Xiangya Second Hospital, Central South University between October 2005 and June 2007. The informed consent was obtained from all subjects. Arteriography was performed. 125 patients with sever underwent direct stenting （stenting group） and the other 90 patients were treated by bypass surgery because of severe multiple-vessel coronary artery disease or gave up stenting due to the medical cost （non-stenting group）. Blood samples of patients were harvested until 24 hours after stenting. Myeloperoxidase, lactoferrin, C-reactive protein and cytokines serum levels were assessed. RESULTS： 215 patients were all included in the result analysis. ①Myeloperoxidase and lactoferrin levels remained following catheterization, whereas a significant increase was found in patients after stenting （P 〈 0.01）. ②No change was found in levels of interleukin （IL）-8 and IL-12 in the blood samples of non-stenting group after catheterization at the different sampling time, but IL-8 and IL-12 levels were increased transiently following stenting. IL-6 values increased in both groups （P 〈 0.05）. ③Baseline values of C-reactive protein were similar in each group. A progressive increase in C-reactive protein was noted in both groups and the values were significantly increased following stenting （P 〈 0.01）. CONCLUSION： In patients with unstable angina, stenting is associated by immediate neutrophil activation. Myeloperoxidase acts as a trigger for the inflammatory reaction in patients with acute coronary syndromes undergoing percutaneous coronary intervention.