急性冠状动脉综合征患者血清肿瘤坏死因子-α和白细胞介素-18的变化及临床意义

Clinical significance of tumor necrosis factor-α and Interleukin-18 in patients with acute coronary syndrome

目的探讨血清肿瘤坏死因子-α和白细胞介素-18在急性冠状动脉综合征患者血清中含量的变化及其临床意义。方法选取急性心肌梗死患者40例、不稳定型心绞痛患者36例、稳定型心绞痛患者30例和非冠心病患者27例为研究对象,AMI组、UAP组和SAP组根据冠状动脉造影结果分为单支病变组26例、双支病变组47例和三支病变组33例。采用放射免疫分析法分别测定血清TNF-α和IL-18含量并与病情程度和病变冠脉支数进行比较分析。结果①AMI组血清TNF-α和IL-18水平显著高于UAP组、SAP组和对照组(均P<0.01),UAP组显著高于SAP组和对照组(均P<0.01),SAP组血清TNF-α水平与对照组无差异(P>0.05),但IL-18水平显著高于对照组(P<0.01);②对照组血清TNF-α和IL-18水平显著低于单支、双支和三支病变组(均P<0.01),单支病变组显著低于双支和三支病变组(均P<0.01),双支病变组血清TNF-α水平与三支病变组无差异(P>0.05),但IL-18水平显著低于三支病变组。结论TNF-α和IL-18与ACS冠脉病变密切相关并介导了动脉粥样斑块的易损和破裂,其血清水平变化可作为冠状动脉粥样硬化斑块炎症反应程度和不稳定破裂的观察指标并有助于诊断和预测ACS的发生、发展和预后。

Objective To investigate the changes of serum tumor necrosis factor-α and interleukin-18 and their clinical significance in patients with acute coronary syndrome. Methods 40 patients with acute myocardial infarction and 36 patients with unstable angina pectoris and 30 patients with stable angina pectoris （SAP group） and another 27 patients without coronary heart disease were included in this study. Patients in AMI group, UAP group and in SAP group were divided into three groups as a single-vessel disease group （n = 26）,a double-vessel disease group （n = 47） and a triple-vessel disease group （n = 33） according to the results of coronary angiography.The concentrations of serum TNF-α and IL-18 were determined by radioimmunoassay and were analyzed with the severity of ACS.Results （1）The concentrations of serum TNF-α and IL-18 in AMI group were significantly higher than that of the UAP group,the SAP group and the control group （all P 〈 0.01 ） and in UAP group were significantly higher than that of the SAP group and the control group （all P 〈 0.01 ）. There were no differences of serum TNF-α comparing between the SAP group and the control group （all P 〉 0.05） but the concentrations of senun IL-18 in SAP group were obviously higher than that of the control group （ all P 〈 0.01 ）. （2） The concentrations of serum TNF-α and IL-18 in control group were significantly lower than that of the single-vessel disease group, the double-vessel disease group and the triple-vessel disease group（all P 〈 0.01 ） and in single-vessel disease group were significantly lower than that of the double-vessel disease group and the triple-vessel disease group （all P 〈 0.01 ）. There were no differences of serum TNF-α comparing between the double-vessel disease group and the triple-vessel disease group （all P 〉 0.05） but the concentrations of serum IL-18 in double-vessel disease group were obviously lower than that of the triple-vessel disease group （all P 〈 0.01 ）. Conclusion TNF-α and IL-18 which are related with the disruption of arterial atheromatous plaque are involved in the coronary artery lesion of ACS. The concentrations of serum TNF-α and IL-18 are important risk and predictive factors for patients with ACS, which are positively correlated with the severity of ACS.