急性心肌梗死患者不同血清白介素6水平对心肌损伤的预测价值

Prediction of serum interleukin-6 level on the myocardial injury in patients with acute myocardial infarction

目的探讨急性心肌梗死（acute myocardial infarction,AMI）患者不同血清白细胞介素6（interleukin 6,IL-6）水平对心肌损伤的预测作用。方法采用临床病例对照诊断研究设计。收集2012年11月至2013年5月在上海新华医院急诊科或心内科就诊的AMI患者54例,健康体检者20名。采用ELISA检测AMI患者发病24 h内血清IL-6和转化生长因子β1（transforming growth factorβ1,TGF-β1）含量,采用流式细胞术检测健康人和AMI患者外周血CD4＋CD25＋Foxp3＋Treg细胞和Th17比例。随机选取AMI患者中IL-6＋（IL-6≥10 ng/L）和IL-6-（IL-6〈10 ng/L）的各10例患者血清标本,应用Luminex方法检测19种细胞因子,同时分析临床生化指标。采用F检验验证数据方差齐性,正态分布数据组间比较采用t检验或方差分析,非正态分布数据采用秩和检验。结果与健康对照组相比,高敏C反应蛋白（high sensitivity C reactive protein,hs-CRP）和肌酸激脢（creatine kinase-MB,CK-MB）在两组AMI中均增高,差异有统计学意义,并且IL-6＋组显著高于IL-6组[hs-CRP：8.43（1.28-10.75）μg/L vs 0.55（0.15-1.35）μg/L,Z=27.3,P〈0.05;CK-MB：25.0（14.0-66.0）μg/L vs11.5（8.8-17.0）μg/L,U=217,P〈0.05]。IL-17、TGF-β、肿瘤坏死因子α（tumor necrosis factorα,TNF-α）和Th17细胞比例在IL-6＋和IL-6-AMI两组中均高于健康对照组,但差异无统计学意义。IL-6＋和IL-6-AMI患者外周血CD4＋CD25＋Foxp3＋Treg细胞比例均低于健康对照组,两组间比较无统计学差异。结论 IL-6＋AMI患者表现出更严重的心肌损伤（以TNI为指标）和炎症反应（hs-CRP、IL-10和IL-8为指标）,IL-6或许可用于AMI风险分层。

Objective To investigate the prediction of serum interleukin-6 （IL-6） level in patients with acute myocardial infarction （AMI） on the myocardial injury. Methods A case control study enrolled 54 patients with AMI in the Department of Emergency and the Department of Cardiology, Xinhua Hospital, and 20 healthy donors from the Medical Examination Center of the same Hospital from November 2012 to May 2013. AMI patients were divided into two groups according to the levels of serum IL-6 within 24 h after attack. The levels of IL-6 and transforming growth factor β1 （TGF-β1） were measured by ELISA. The serum levels of the other 19 cytokines were measured using Luminex assay. CD4＋CD25＋Foxp3＋Treg and Th17 cells were analyzed by flow cytometry. Both clinical and biochemical indicators were measured and analyzed in the Department of Laboratory. Results BCompared with the healthy donors, the levels of high sensitivity C reactive protein （hs-CRP） and creatine kinase-MB （CK-MB） were significantly higher in the two AMI groups （all P 〈 0.05）; and the levels in IL-6＋ group were significantly higher than those in IL-6 group （hs-CRP： 8.43 （1.28-10.75） μg/L vs 0.55 （0.15-1.35） μg/L, Z=27.3, P〈0.05; CK-MB： 25.0 （14.0-66.0） μg/L vs 11.5 （8.8-17.0） μg/L, U=217, P〈0.05）. The levels of IL-17, TGF-β, tumor necrosis factor α （TNF-α, and Th17 cells in IL-6＋ and IL-6- AMI were both significantly higher than the normal donors, while there was no difference between two AMI groups. CD4＋CD25＋Foxp3＋Treg cells in IL-6＋ and IL-6-AMI patients were both lower than those in normal donors, while there was also no difference between the two AMI groups. Conclusions IL-6＋AMI patients presented more severe myocardial damage （TNI as indicator） and inflammation （hs-CRP, IL- 10 and IL-8 as indicator）. IL-6 could be used for the risk stratification in AMI.