糖尿病对行直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者白细胞介素6、肿瘤坏死因子α水平的影响

Effects of diabetes on interleukin 6 and tumor necrosis factorαlevels in patients with acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

目的观察行直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者不同时间点的血清白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平,以及在不同糖代谢状态下(糖代谢正常组和糖尿病组)的变化。方法采用前瞻性研究方法,连续入选首都医科大学附属北京友谊医院心内科住院、首次诊断为STEMI并接受直接PCI治疗的151例患者,分别于3个不同时间点采集空腹静脉血(包括入院即刻、48 h、第5天),测定血清IL-6、TNF-α水平,并连续测定心肌酶谱(肌酸激酶同工酶、肌钙蛋白)及N末端B型利钠肽原(NT-proBNP)水平。按照口服糖耐量试验进行分组,包括血糖调节正常组(37例)、血糖调节异常组(37例)、新诊断糖尿病组(35例)和既往糖尿病组(42例)。同时对照组纳入40例均经影像学检查证实冠状动脉狭窄<50%,包括糖代谢正常患者20例和糖尿病患者20例,均测定血清IL-6、TNF-α水平。采用线性回归分析IL-6、TNF-α与心肌酶和NT-proBNP的相关性。结果行直接PCI的151例STEMI患者中,114例(75.5%)合并糖代谢异常。STEMI患者48 h及第5天的IL-6水平较入院即刻相比较有上升趋势;48 h的TNF-α水平较入院即刻有显著上升(69.9 ng/ml比53.3 ng/ml,P=0.000);第5天的TNF-α水平与入院即刻相比亦有显著上升(63.2 ng/ml比53.3 ng/ml,P=0.005)。不论是否合并糖尿病,STEMI患者入院血清IL-6水平均显著高于对照组(糖尿病组:57.6 ng/ml比42.7 ng/ml,P=0.001;糖代谢正常组:56.8 ng/ml比33.6 ng/ml,P=0.002)。STEMI患者入院血清TNF-α水平均显著高于对照组(糖尿病组:57.2 ng/ml比36.6 ng/ml,P=0.01;糖代谢正常组:49.1 ng/ml比24.5 ng/ml,P=0.001)。STEMI患者中,与糖代谢正常组相比,合并糖尿病组48 h、第5天两个不同时间点的IL-6、TNF-α水平均明显升高(均为P<0.05)。相关性分析结果提示PCI术后48 h时血清IL-6、TNF-α水平与肌酸激酶同工酶、肌钙蛋白的峰值均无显著相关性(均为P>0.05)。结论行直接PCI的STEMI患者的血清IL-6、TNF-α水平明显升高,而合并糖尿病患者的水平更高,持续时间长。

Objective To investigate plasma interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)levels at different time points in patient’s with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI)with or without diabetes.Methods This was a prospective observational study.A total of 151 STEMI patients undergoing primary PCI who were admitted to Department of Cardiology,Beijing Friendship Hospital,Capital Medical University were consecutively enrolled.Levels of IL-6,TNF-α,creatine kinase-MB(CK-MB),cardiac troponin(cTn),and N-terminal pro--B-type natriuretic peptide(NT-proBNP)were tested shortly after admission,at 48 h after PCI,and 5 d after hospitalization.According to the result of oral glucose tolerance test,all were divided into the normal glucose regulation(NGR)group(n=37),impaired glucose regulation(IGR)group(n=37),novel diabetes mellitus(N-DM)group(n=35)and previous DM(p-DM)group(n=42).During the same period,40 patients with coronary artery stenosis<50%detected by coronary imaging were included as control group,including those with(n=20)or without DM(n=20).Results Of 151 STEMI patients who underwent primary PCI,114(75.5%)had abnormal glucose regulation.Among those,there was a trend of increased level of IL-6 detected at 48 h and 5 d compared with that immediately after admission.TNF-αlevel increased significantly at 48 h(69.9 ng/ml vs.53.3 ng/ml,P=0.000)and 5 d(63.2 ng/ml vs.53.3 ng/ml,P=0.005)compared with that after admission.Compared with control group,levels of IL-6(DM group:57.6 ng/ml vs.42.7 ng/ml,P=0.001;NGR group:56.8 ng/ml vs.33.6 ng/ml,P=0.002)and TNF-α(DM group:57.2 ng/ml vs.36.6 ng/ml,P=0.01;NGR group:49.1 ng/ml vs.24.5 ng/ml,P=0.001)were significantly higher in STEMI group whether combined with diabetes or not.Among the STEMI patient,those with DM had significantly increased levels of IL-6 and TNF-αdetected at 48 h and 5 d after admission compared to NGR group(all P<0.05).Correlation analysis showed no significant relationship among serum levels of IL-6,TNF-αdetected at 48 h after PCI and the peak levels of CK-MB and cTn(all P>0.05).Conclusions Levels of IL-6 and TNF-αelevate after primary PCI in patients with STEMI,and are higher and last longer in those with DM.