早期PCI治疗对心肌梗死合并多发性感染患者炎症因子的影响

Effect of early interventional therapy on inflammatory factors in patients with myocardial infarction complicated with multiple infections

目的探讨心肌梗死(AMI)患者合并多发性感染早期冠心病经皮冠状动脉介入治疗(PCI)的效果及对炎症因子的影响。方法选择2016年1月-2017年7月医院早期PCI的AMI合并多发性感染患者50例,设为试验组,将仅行诊断性冠脉造影的50例AMI合并多发性感染患者设为对照组;评估试验组治疗效果,对比两组预后;对比两组术前(造影前)、术后(造影后)12h、24h、48h、90d时白细胞介素-6(IL-6)、IL-18、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)水平;将试验组按是否发生心血管事件(MACE)分为MACE患者和无MACE组患者,对比两组上述指标。结果试验组90d MACE发生率为34.00%(17/50)低于对照组62.00%(31/50)(P=0.005);术后12h、24h、48h试验组IL-6、IL-18、TNF-α、hs-CRP均高于对照组(P均<0.05),90d时试验组上述指标水平均降低,与对照组接近,差异无统计学意义。术后3d MACE患者IL-6、IL-18、hs-CRP、TNF-α分别为(79.82±10.17)pg/ml、(139.09±16.52)ng/ml、(30.57±6.98)mg/L、(29.58±7.52)ng/ml高于无MACE患者(P<0.001)。结论介入治疗可引起AMI合并多发性感染患者短期内血清IL-18、IL-6、TNF-α、hsCRP水平升高,提示可能导致炎性反应,但介入治疗能改善近期预后,而炎症指标可能成为预估患者预后的重要指标。

OBJECTIVE To investigate the efficacy of early percutaneous coronary intervention（PCI）in myocardial infarction（AMI）patients with multiple infections and its effect on the level of inflammatory factors in the patients.METHODS A total of 50 patients with AMI complicated with multiple infections that received early interventional treatment in the hospital from Jan. 2016 to Jul. 2017 were enrolled as the experimental group,and another 50 patients with AMI and multiple infections who underwent diagnostic coronary angiography were selected as the control group.The treatment effect of the experimental group was evaluated,and prognosis was compared between the two groups.The levels of interleukin-6（IL-6）,interleukin-18（IL-18）,tumor necrosis factor-α（TNF-α）,and hypersensitive C-reactive protein（hs-CRP）were compared between the two groups before and after the operation.The experimental group was divided into MACE group and no MACE group according to occurrence of cardiovascular events.The above indexes were compared between the two groups.RESULTS The incidence of MACE on day 90 was 34.00%（17/50）in the experimental group,significantly lower than that of the control group,which was 62.00%（31/50）（P=0.005）.The levels of IL-6,IL-18,TNF-α-hs-CRP in the experimental group were significantly higher than those in the control group（P〈0.05）at 12 h,24 hand 48 h after operation,but all these levels decreased on day 90,which were similar to those in the control group.The IL-6,IL-18,hs-CRP,TNF-αlevels of MACE patients on day 3 after operation were respectively（79.82±10.17）pg/ml,（139.09±16.52）ng/ml,（30.57±6.98）mg/L,（29.58±7.52）ng/ml,significantly higher than those of the group without MACE（P〈0.001）.CONCLUSIONInterventional therapy can lead to short-term increase of IL-6,serum IL-18,TNF-alpha,Hs-CRP levels in AMI patients with multiple infections,implying occurrence of inflammatory reaction,but the intervention treatment can improve the short-term prognosis,and inflammation may be an important index to estimate the prognosis of the patients.