急性冠脉综合征患者Th/Tregs水平的变化及其临床意义

Evaluation of plasma Th/Tregs levels in patients with acute coronary syndrome and their clinical significance

目的研究白介素17(IL-17)、白介素35(IL-35)在急性冠脉综合征(ACS)患者外周血中的表达,探讨该指标与肌钙蛋白I(c Tn I)、B型钠尿肽(BNP)及左室射血分数(LVEF)等是否存在相关性。方法选取2016年7月至2017年9月在广州中医药大学第一附属医院住院的ACS患者143例,其中ST段抬高型急性心肌梗死(STEMI)37例,非ST段抬高型急性心肌梗死(NSTEMI)45例,不稳定心绞痛61例;同期体检健康者30例为对照组。以ELISA法检测血清IL-17、IL-35水平,超声心动图Simpson法测定LVEF值。指标间相关性采用Pearson相关分析。结果 STEMI组患者的IL-35、IL-17水平[40.71±14.96)pg/m L、(45.72±13.75)pg/m L]与UAP组[(79.84±21.41)pg/m L、(15.64±9.83)pg/m L]比较差异均有统计学意义(P<0.05),而STEMI与NSTEMI组患者的IL-35水平[(45.96±17.52)pg/m L]和IL-17水平[(39.13±10.94)pg/m L]比较差异均无统计学意义(P>0.05);ACS患者IL-17水平与c Tn I、BNP及D-Dimer呈负相关(r=-0.652,-0.571,-0.484,P<0.05),与LVEF呈正相关(r=0.436,P<0.05);IL-35水平与c Tn I、BNP及D-Dimer呈正相关(r=0.573,0.416,0.597,P<0.05),与LVEF呈负相关(r=-0.391,P<0.05)。结论 ACS患者外周血IL-17、IL-35水平在一定程度上能反映ACS的病情严重程度,可作为冠心病急性心血管事件的独立预测指标。

Objective To investigate the levels of IL-17 and IL-35 in patients with acute coronary syndrome（ACS）, and to explore the correlation between them and cardiac troponin I（c Tn I）, brain natriuretic peptide（BNP）, left ventricular ejection fraction（LVEF）. Methods A total of 143 cases of patients with ACS, including 45 cases of ST elevation acute myocardial infarction（STEMI）, 37 cases of non-ST segment elevation acute myocardial infarction（NSTEMI）, and61 cases of unstable angina patients（UAP）, who admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from July 2016 to September 2017, were selected as the research subjects. At the same time, a total of 30 cases of physical examination in our hospital were selected as the control group. Serum IL-17, IL-35 were detected by ELISA, and the echocardiography LVEF values were determined by Simpson method. The correlation between the indexes was analyzed by Pearson correlation. Results The levels of IL-35 and IL-17 were respectively（40.71±14.96） pg/m L and（45.72±13.75） pg/m L in the STEMI group versus corresponding（79.84±21.41） pg/m L and（15.64±9.83） pg/m L in the UAP group（P〈0.05）; but there was there was no significant difference between the STEMI and NSTEMI group,（45.96±17.52） pg/m L and（39.13±10.94） pg/m L, in the levels of IL-35 and IL-17（P〉0.05）. The level of IL-35 in the patients with ACS were negatively correlated with c Tn I, BNP, D-Dimer（r=-0.652,-0.571,-0.484, respectively）, and positively correlated with LVEF（r=0.436, P〈0.05）; while the IL-17 level were positively correlated with c Tn I, BNP, D-Dimer（r=0.573, 0.416, 0.597, P〈0.05）, and negatively correlated with LVEF（r=-0.391, P〈0.05）. Conclusion The levels of IL-17 and IL-35 in the peripheral blood of ACS patients can reflect the severity of ACS in a certain extent, and can be used as an independent predictor of acute cardiovascular events in coronary heart disease.