炎性相关细胞因子和心肌梗死微循环再灌注状态的关系

Relation between inflammation related cytokines and myocardial microcirculatory reperfusion state

目的 观察急性心肌梗死 (AMI)患者梗死相关血管 (IRA)开通前后炎性细胞因子的动态变化及其与心肌组织水平灌注状态的关系。方法 (1)测定 8例健康人和 2 2例AMI患者急诊冠状动脉介入治疗术 (PCI)前即刻 ,术后 12、2 4h ,血浆白细胞介素 (IL) 1β、肿瘤坏死因子 (TNF)α、IL 10的变化。 (2 )按照再灌注后 2h心电图ST段回落是否 >70 % ,将 2 2例AMI患者分为 :A组 (ST回落≥ 70 % )12例和B组 (ST回落 <70 % ) 10例 ,比较两组患者IL 1β、TNFα、IL 10的变化幅度。 结果 (1)治疗前A、B两组AMI患者血浆TNFα、IL 10略高于健康对照组 ,但差异无统计学意义 (P >0 0 5 ) ;而IL 1β显著高于健康对照组 (P <0 0 5 ) ;再灌注后 12、2 4hA、B两组血浆IL 1β和TNFα均较术前显著增高 (P <0 0 1,P <0 0 5 ) ,B组血浆IL 10较术前显著增高 (P <0 0 5 ) ,A组则无此变化 (P >0 0 5 )。 (2 )A、B两组间比较 ,治疗前TNFα、IL 1β、IL 10差异均无显著性 (P >0 0 5 ) ;成功PCI、IRA血流达TIMI 3级者 ,B组患者血浆IL 1β、TNFα、IL 10 ,在再灌注 12h显著高于A组 (P <0 0 1,P <0 0 5 ,P <0 0 5 ) ,再灌注 2 4h ,IL 1β、IL 10仍然高于A组 (P <0 0 5 )。 (3)A、B两组患者抗炎因子IL

Objective To observe the dynamic fluctuation of inflammatory cytokines(IL-1β、TNFα)and anti-inflammatory cytokine(IL-10) in acute myocardial infarct(AMI )patients before and after recanalization of infarct related artery (IRA) and analyze the relationship between fluctuation of cytokines and reperfusion state of myocardial tissue. Methods (1)In 22 AMI patients and 8 healthy subjects, plasma IL-1β、TNFα and IL-10 were measured with ELISA before emergency percutaneous coronary interposition (PCI), 12 h and 24 h post-intervention. (2)The 22 AMI patients were further divided into 2 groups according to ST-segment change in ECG at 2h after reperfusion: group A, good reperfusion of myocardium, ST↓≥70%( n =12) and group B, poor reperfusion of myocardium, ST↓<70%(n=10). The change of plasma levels of IL-1β, TNFα and IL-10 of the two groups was compared. Results (1) Plasma TNFαand IL-10 in group A and B were not significantly higher those that the healthy controls ( P >0.05) before emergency PCI, but IL-1β was significantly higher ( P <0.05). Plasma IL-1βand TNFα in group A and B and IL-10 in group B at 12 h and 24 h post-intervention were significantly higher than those before PCI ( P <0.01, P <0.05, P <0.05), while IL-10 in group A was not ( P >0.05). (2) Plasma IL-1β, TNFα and IL-10 in group B were not higher than those in group A before PCI, but they were significantly higher at 12 h post-PCI ( P <0.01, P <0.05, P <0.05) and IL-1β and IL-10 were still higher at 24 h post-PCI( P <0.05). The increment of IL-10 was significantly less than that of IL-1β and TNFα in group A and B( P <0.01, P <0.05). Conclusions Cytokines may be involved in myocardial ischemia-reperfusion injury and increase of inflammatory cytokines may be a marker of poor myocardial microcirculatory reperfusion.