不同戒烟时间与正在吸烟AMI患者溶栓再通前后炎症因子表达的差异

Inflammatory cytokines differential expression in acute myocardial infarction with smoking and different smoking cessation time after successful thrombolysis

目的:探讨不同戒烟时间AMI和正在吸烟AMI患者溶栓再通前、后IL-1、TNF-α和IL-10表达的差异。方法:AMI患者80例,根据患者吸烟状态将患者分为不吸烟AMI组、吸烟<5年AMI组、戒烟≤5年AMI组和戒烟>5年AMI组,每组均20例,采用重组链激酶静脉溶栓,分别于溶栓治疗前、溶栓治疗再通后12h和24h采集静脉血,观察IL-1、IL-10和TNF-α的变化。结果:各组IL-1、TNF-α和IL-10溶栓治疗前后在不同时间点的变化均具有统计学意义(P<0.01)。吸烟<5年AMI组和戒烟≤5年AMI组溶栓治疗后,随时间延长,3种炎症因子逐渐升高,但不吸烟组和戒烟>5年组溶栓后12h和24hIL-1、TNF-α和IL-10的差异无统计学意义(P>0.05)。溶栓治疗前、溶栓后12h和溶栓后24h,3种炎症因子表达水平吸烟<5年AMI组和戒烟>5年AMI组均高于不吸烟组,吸烟<5年AMI组高于戒烟>5年AMI组,差异有统计学意义(均P<0.01);但不吸烟AMI组和和戒烟>5年AMI组,吸烟<5年AMI组和戒烟≤5年AMI组的差异无统计学差异(P>0.05)。结论:吸烟可上调AMI患者溶栓再通后炎症因子的表达,加重和延长缺血再灌注损伤,损伤时间可达24h,戒烟>5年可下调3种炎症因子的表达,减轻缺血再灌注损伤。

Objective：To explore the IL-1 ,TNF-α and IL-10 differential expression in acute myocardial infarc-tion with smoking and different smoking cessation time after successful thrombolysis. Method： According to the smoking status,the AMI patients who are smoking after successful thromholysis were divided into 4 groups,no smokers, smoking〈5 years, smoking cessation≤5 years and smoking cessation〉5 years, 20 cases in each group. All the patients with acute myocardial infarction were treated with recombinant streptokinase. Every group＇s serum samples were collected before thrombolytic therapy and after thrombolytic therapy at 12th hours, 24th hours re-spectively. The changes of IL-1, TNF-a and IL 10 levels were observed. Result.. At different time points in each group, The IL-1 ,TNF-α and IL-10 levels after successful thrombolysis at 12th hours and 24th hours were all high er than before thrombolytic therapy （P〈0.0l）, however, no significant differences were found between 12th hours and 24th hours after thrombolytic therapy in smoking cessationS5 years group and no smokers group （P〉0.05）. Comparison in groups at three time points,the IL-1 ,TNF-α and IL-10 levels in smoking〈5 years and smoking ces- sation〉5 years were significantly higher than no smokers. But no significant differences were found between no smokers and smoking cessation≤5 years, smoking〈 5 years and smoking cessationS〉 5 years （P〉 0.05 ）. Conclu-sion：Smoking can increase the expression levels of serum IL-1 ,TNF-α and IL-10 in AMI patients after intravenous thrombolysis reperfusion, which caused the myocardial ischemia reperfusion injury heavily and extended injury time,it was continuing to 24h. Smoking cessation more than 5 years the myocardial ischemia reperfusion injury was basically the same as no smokers.