冠状动脉介入治疗对急性冠状动脉综合征白细胞介素-37、超敏C反应蛋白、单核细胞及中性粒细胞与淋巴细胞比值的影响

Effect of percutaneous coronary intervention on IL-37, hs-CRP,monocytes, neutrophil and lymphocyte ratio in patients with acute coronary syndrome

目的探讨经皮冠状动脉介入治疗(PCI)对急性冠状动脉综合征(ACS)患者血浆白细胞介素-37(IL-37)水平、超敏C反应蛋白(hs-CRP)水平、单核细胞计数、中性粒细胞与淋巴细胞比值(NLR)的影响,评估上述炎症指标与ACS类别、Gensini评分、心脏重构和功能关系。方法检测58例ACS患者PCI术前及术后24 h血浆IL-37、hs-CRP水平、单核细胞(M)计数及NLR,常规检测血脂、血浆N端脑钠肽前体(NT-pro BNP)水平、左室舒张末期内径(LVEDD)和左室射血分数(LVEF)。另选同期因胸痛入院且排除冠状动脉粥样硬化性心脏病(冠心病)患者30例为对照组。结果与对照组比较,ACS患者PCI术前血浆hs-CRP水平、M计数及NLR均显著增高,血浆IL-37水平显著降低(P均<0.05);与PCI术前比较,ACS患者术后血浆hs-CRP水平、M计数及NLR增高,血浆IL-37水平降低(P均<0.05)。ACS患者PCI术前血浆IL-37水平与Gensini评分呈负相关;hs-CRP水平、M计数、NLR与Gensini评分、LVEDD和NT-pro BNP水平呈正相关,NLR与LVEF呈负相关。结论 PCI导致体内抗炎/促炎反应失衡加重;PCI术前炎症指标一定程度上反映ACS患者冠状动脉病变严重程度、心室重构和心功能损伤状况。

Objective To investigate the effect of percutaneous coronary intervention（PCI） on anti-inflamation factors IL-37, hs-CRP, monocytes, neutrophil and lymphocyte ratio in patients with acute coronary syndrome and to evaluate the correlation between inflammatory index and Gensini score, cardiac remodeling and function. Methods The levels of plasma IL-37, hs-CRP, periphera monocyte, neutrophil and lymphocyte were detected in 58 patients with ACS 24 hours before and after PCI. Plasma levels of NT-pro BNP, left ventricular end diastolic diameter（LVEDD） and left ventricular ejection fraction（LVEF） were measured as well. Total 30 subjects with chest pain and without coronary heart disease were selected as control group. Results Compared with the control group, the serum hs-CRP levels, peripheral blood monocyte counts and NLR of the ACS group were significantly higher, and the plasma level of IL-37 was lower in the patients of ACS group（P〈0.05）. Compared with preoperative state, the peripheral blood monocyte counts, NLR and the serum hs-CRP levels were increased significantly, and the serum levels of IL-37 decreased after PCI were increased（P〈0.05）. Preoperative plasma IL-37 levels were negatively correlated with Gensini scores. Preoperative plasma hs-CRP levels, monocyte counts, NLR and were positively related to Gensini scores, LVEDD and NT-pro BNP levels. Preoperative NLR was negatively correlated with LVEF.Conclusions PCI surgery leads further aggravate imbalance of anti-inflammatory /pro-inflammatory response in vivo.The inflammatory indexes such as IL-37 level, hs-CRP, monocyte counts, NLR before PCI reflect coronary lesion severity and ventricular remodeling and heart function in a certain extent in patients with ACS.