急性冠状动脉综合征患者炎症相关分子水平变化的临床意义

Clinical Significance of Inflammation-related Molecular Level Changes in Acute Coronary Syndrome

目的观察在不同类型冠心病(CHD)患者血清中,白介素-6(IL-6)、IL-18、C反应蛋白(CRP)、基质金属蛋白酶-2(MMP-2)、单核细胞趋化蛋白-1(MCP-1)等分子水平及血脂变化,探讨其在急性冠状动脉综合征(ACS)发病中的作用及其与冠状动脉病变程度的相关性及诊断意义。方法急性心肌梗死(AMI)组31例、不稳定型心绞痛(UAP)组32例、稳定型心绞痛(SAP)组35例,另选取同期30例正常健康者为对照组。酶联免疫吸附法(ELISA)测定血清IL-6、IL-18、MMP-2、MCP-1和CRP的浓度;速率散射法测血清CRP水平;血脂及脂蛋白含量测定分别用酶化学法与直接测定法检测。结果急性冠脉综合征患者(ACS)IL-6、IL-18和CRP水平,均显著高于对照组(P<0.05,P<0.01)和SAP组患者(P<0.05,P<0.01)。随着病情的加重,IL-6、IL-18、MMP-2和MCP-1水平均表现出进行性升高的趋势。患者血清IL-6、IL-18与CRP水平显著相关;患者血清IL-6与IL-18水平亦呈正相关。结论 ACS实际上是炎症、免疫、脂质代谢紊乱等多种因素综合作用的结果,所以对ACS的诊断,应综合炎症、脂类代谢等多种因素,进行评价各检测指标的诊断意义;IL-6、IL-18与CRP,可作为ACS发病和冠脉病变不稳定严重程度的预测因子。

Objective To observe the changes of serum IL-6,IL-18,C-reactive protein（CRP）,matrix metalloproteinase-2（MMP-2）,monocyte chemoattractant protein-1（MCP-1） and blood lipid in different types of coronary heart disease（CHD） patients.To explore the acute coronary syndrome（ACS） and its role in the pathogenesis of coronary artery lesions with the degree of relevance and diagnostic significance.Methods Acute myocardial infarction（AMI） group 31 cases,unstable angina pectoris（UAP） group 32 cases,unstable angina pectoris（SAP） group 35 cases,and the other select the same period 30 cases of normal control group.Enzyme-linked immunosorbent assay（ELISA） for determination of serum IL-6,IL-18,MMP-2,MCP-1 and CRP concentrations;scattering rate measured serum CRP levels;determination of blood lipid and lipoprotein enzyme chemical method used separately with Direct determination method.Results The patients with ACS IL-6,IL-18 and CRP were significantly higher（P〈0.05,P〈0.01） and SAP patients（P〈0.05,P〈0.01）.As the disease increase,IL-6,IL-18,MMP-2 and MCP-1 showed the water to increase the average trend.Serum IL-6,IL-18 and CRP levels significantly correlated;serum IL-6 and IL-18 level was also positively correlated.Conclusion ACS are the results of the complex actions by inflammation,immunity,lipid metabolism disorders and many other factors.The diagnosis of ACS should be general inflammation,lipid metabolism,such as a variety of factors,a comprehensive evaluation of the diagnostic significance of detection of targets;IL-6,IL-18,and CRP can be used as ACS and unstable coronary artery disease incidence and severity of the prediction factor.