探讨白细胞介素-6、肿瘤坏死因子-α等血清炎性因子在急性心梗中的应用价值

The application value of inflammatory cytokines interleukin-6,tumor necrosis factor-α and so on in the diagnosis of acute myocardial infarction

目的探讨急性心肌梗死(acute myocardial infarction,AMI)患者血清中白细胞介素-6(interleukin,LL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)的水平变化及其临床意义。方法收集我院2012年10月至2013年10月,门急送检并经冠状动脉造影确诊为AMI的患者83例,根据心肌肌钙蛋白T(cardiac troponin T,cTnT)水平分为cTnT弱阳性组28例,cTnT阳性组55例,同期收集健康体检者30例为健康对照组。检测所有受试者血清IL-6、TNF-α、hs-CRP水平,测定结果与心肌酶谱中敏感性最高的肌酸激酶同工酶(creatine kinase-MB,CK-MB)相比较,并对检测结果进行统计学分析。结果三组间CK-MB、IL-6、TNF-α、hsCRP检测结果比较差异均具有统计学意义(P均<0.05)。cTnT阳性组患者血清CK-MB、IL-6、TNF-α、hs-CRP水平均明显高于健康对照组,且差异均具有统计学意义(P均<0.05)。cTnT弱阳性患者组血清IL-6、TNF-α、hs-CRP水平均显著高于健康对照组及cTnT阳性组,差异均有统计学意义(P均<0.05)。CK-MB水平在cTnT阳性组与弱阳性组之间差异无统汁学意义(P>0.05)。cTnT弱阳性患者组中IL-6、TNF-α、hs-CRP异常率明显高于cTnT阳性组,且差异均有统计学意义(P均<0.05)。cTnT阳性患者组中CK-MB异常率与cTnT弱阳性组差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,IL-6、TNF-α、hs-CRP均是AMI的独立危险因素(P均<0.05)。结论 IL-6、TNF-α、hs-CRP等炎性指标与AMI发生、发展相关,与cTnT联合检测对AMI早期诊断具有较好的临床应用价值。

Objective To investigate the clinical value of interleukin-6（IL-6）, tumor necrosis factor-α （TNF-α）, high sensitive C-reactive protein （hs-CRP） changes in patients with acute myocardial infarction（AMI）. Methods 83 cases outpatient and emergency patients diagnosed AMI by coronary angiography in our hospital from October 2012 to October 2013 were collected. They were divided into weakly positive group （28 cases） and positive group（55 cases） according to cardiac troponin T（cTnT） level, 30 cases health examination people were collected as healthy control group. The levels of IL-6, TNF-α, hs-CRP were detected, and the results were compared with creatine kinase isoenzyme （CK-MB） which has highest sensitivity, the resuits were analyzed statistically. Results There were statistical significance in the differences of IL-6, TNF-α and hs-CRP levels among three groups （Pall〈 0.05 ）. The levels of IL-6, TNF-α, hs-CRP and CK-MB in cTnT positive group were all higher than that in healthy control group, and the differences all had statistical significance （Pall〈 0.05）. The levels of IL-6, TNF-α and hs-CRP in cTnT weakly positive group were all higher than that of cTnT positive group and healthy control group, and the differences all had statistical significance （Pall〈 0.05）. There was no statistical significance in the difference of CK-MB between cTnT positive group and cTnT weakly positive group （P〉 0.05 ）. The abnormal rate of IL-6, TNF-α and hs-CRP in cTnT weakly positive group were significantly higher than that of cTnT positive group, and the differences all had statistical significance（Pall 〈 0.05 ）. There was no statistical significance in the difference of CK-MB abnormal rate between cTnT positive group and cTnT weakly positive group （P〉 0.05 ）. The results of logistic regression found that IL-6, TNF-α and hs-CRP all were independent risk factors for AMI （Pall〈 0.05）. Conclusion IL-6, TNF-α and hs-CRP are all associated with the development of AMI and combined with cTnT will have a better clinical value for the early diagnosis of AMI.