急性心肌梗死患者血浆肿瘤坏死因子α与高敏C反应蛋白变化意义

Change and significance of plasmic TNF-α and hsCRP in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者在经皮冠状动脉介入治疗(PCI)术前及术后血浆肿瘤坏死因子α(TNF-α)与高敏C反应蛋白(hsCRP)的变化及意义。方法采用固相夹心酶联免疫法测定50例AMI患者发病后6～12小时(PCI术前)、术后24小时、48小时、72天、5天、7天、14天及25例对照组术前TNF-α与hsCRP浓度;将AMI组分为3个亚组:无并发症组、并发症组和死亡组。结果AMI组术前血浆TNF-α和hsCRP的浓度明显高于对照组,TNF-α分别为(119.4±67.58)ng/Lvs(19.64±7.55)ng/L,hsCRP(1.43±0.93)mg/Lvs(0.52±0.16)mg/L(均P<0.01);在3个亚组中,TNF-α和hsCRP均出现先升高后降低,病情越严重,升高的峰值越靠后,至术后14天无并发症组和并发症组均已下降到术前水平,而死亡组仍高于术前水平,3组的组间、不同时点以及组间和不同时点的交互作用差异均有统计学意义。结论AMI患者血浆TNF-α与hsCRP浓度明显升高,其峰值延迟甚至持续不降提示病情严重,二者同时测定可作为判断AMI患者急诊PCI术后近期预后的指标。

Objective To investigate the change and significance of plasma tumor necrosis factor-alpha（TNF-α） and high sensitivity C-reactive protein（hsCRP） in acute myocardial infarction（AMI） patients with emergency percutaneous coronary intervention（PCI）.Methods Plasma level of TNF-α and hsCRP in 50 AMI patients were assayed within onset 6-12 hours of AMI（before PCI） and at 24 h,48 h,72 h,5 d,7 d and 14 d by enzyme-linked immunosorbent assay（ELISA）.The AMI group was divided into 3 sub-groups：the death group,the complication group and the no complication group.Meanwhile,the plasma level of the two inflammatory factors in 25 controls also were detected before coronary artery angiography.Results Plasma level of TNF-α and hsCRP at preoperation were higher in patients with AMI than those of controls,respectively TNF-α （119.4±67.58） ng/L vs （19.64±7.55） ng/L and hsCRP （1.43±0.93） mg/L vs （0.52±0.16） mg/L （both P0.01）;In the three sub-groups,plasma concentrations of TNF-α and hsCRP were increased first and then decreased,the plasma level of the complication group and the no complication group had been desended to pre-PCI level on 14 days after PCI,while the death group was still higher than pre-PCI levels.Among three groups,the differenet time points and the interaction among groups and the different time points,all the differences were statistically significance.Conclusion The concentrations of plasma TNF-α and hsCRP are significantly increased in patients with AMI,the peak values which were delayed or continued not to desend demonstrates a serous condition,the simultaneous determination of both factors in AMI patients can be used as recent prognostic indicators after emergency PCI.