TNF-α和IL-6检测在急性冠脉综合征发病中的意义

The Role of Proinflammatory Cytokines (TNF-α and IL-6) in Acute Coronary Syndromes.

目的 探讨急性冠脉综合征患者血清TNF -α和IL -6的浓度与发病的关系。方法 选择急性冠脉综合征 (急性心肌梗死及不稳定心绞痛 )患者 3 6例 ,其中急性心肌梗死 7例 ,不稳定心绞痛患者 2 9例。根据不稳定心绞痛患者病情的严重程度将其按Braunwald分级分为三组 :Ⅰ级 9例 ;Ⅱ级 8例 ;Ⅲ级 12例。采用放免法测定急性冠脉综合征患者血清TNF -α和IL -6的浓度。结果 不稳定心绞痛患者由Ⅰ级组到Ⅲ级组随病情加重IL -6的浓度是逐渐升高的(P <0 .0 5 ) ,但血清TNF -α无明显升高 ;急性心肌梗死患者血清IL -6浓度在心梗发作后 6小时和 48小时有两个高峰 ,血清TNF -α在心梗发作后 2 4小时达到高峰 ;IL -6和TNF -α与反映心肌损伤的酶CK -MB无直线相关性。结论 不稳定的心绞痛患者随着病情加重体内IL -6水平逐步升高 ;AMI患者发病过程中伴随IL -6和TNF -α的升高 ,但IL -6和TNF -α的动态曲线不同 ;IL -6和TNF

Objective TO assess the role of serum proinflammatory cytokines(interleukin-6 and TNF-α)in patient with acute coronary syndromes.Methods 36 patients with acute coronary syndromes were included in study.Among them,7 patients were diagnosed as acute myocardial infarction(AMI),29 patients were unstable angina(UA).According to the severity of disease,the patients with UA were divided into three groups:group l (n=9,Braunwald's class I);group 2(n=8,Braunwald's class II);group 3 (n=12,Braunwald's class III).Serum levels of IL-6 and TNF-α were measured by specific radioimmunoassays.Serum IL-6 and TNF-α levels in 7 patients with AMI were measured at 6,12,18,24 and 36 hours after onset of AMI to assess the time course of proinflammation cytokines. Results serum IL-6 level in patients with UA increased with the severity of disease ( P <0.05),but not for TNF-α level. The peak value of IL-6 in patients with AMI was at 6 and 48 hours after onset of AMI,a peak of TNF-α was at 24 hours.Neither the level of IL-6 nor TNF-α had relationship with CK-MB (an enzyme,indicating myocardial injury).Conclusions Level of IL-6 is related with the severity of unstable angina. The increase of IL-6 and TNF-α during the course of myocardial infarction suggested that these proinflammatory cytokines participated in myocardial ischemia-reperfution injury.The increase of IL-6 and TNF-α don't relate with the extent of myocardial tissue in jury.