摘要
目的 观察急性心肌梗死患者经皮冠状动脉介入（PCI）治疗前后血清炎症因子白细胞介素（IL）及单核细胞趋化蛋白1（MCP-1）的动态变化及其相关关系.方法 2008年6-12月连续收集北京大学第三医院心内科住院的急性ST段抬高型心肌梗死（STEMI）患者59例.采用双抗体夹心ELISA分别检测STEMI患者PCI术前即刻、术后4～6、12、24 h、7 d血清IL-6、IL-8、MCP-1及IL-10的水平,比较不同时间血清炎症因子水平的变化,并对其炎症因子水平的自然对数作相关分析.结果 PCI术后12 h血清IL-6、IL-8（中位数）水平均显著高于术前（IL-6：8.51 ng/L比6.76 ng/L,IL-8：4.67ng/L比2.95 ng/L,均P＜0.05）.在PCI术后4～6 h及12 h,MCP-1的水平均显著高于术前（35.04ng/L,34.24 ng/L比30.45 ng/L,均P＜0.05）;而IL-10的水平比术前均显著降低（18.15 ng/L,18.82ng/L比20.95 ng/L,均P＜0.05）.PCI术前IL-6及IL-10水平与入院时心功能Killip分级均具有显著相关性（IL-6：r=0.293,P＜0.05;IL-10：r=-0.287,P＜0.05）,PCI术前IL-8水平与胸痛发作时间呈负相关（r=-0.299,P＜0.05）.心肌梗死的部位、射血分数与各种炎症因子的水平差异无统计学意义（P＞0.05）;在各时间点,血清IL-6、IL-8及MCP-1浓度之间呈显著正相关性（P＜0.01）,分别与IL-10的呈显著负相关性（P＜0.01）.结论 心肌缺血再灌注后致炎因子水平升高而抗炎因子水平降低,机体存在炎症/抗炎状态失衡.
Objective To investigate the temporal changes of serum cytokines IL-6,IL-8,MCP-1 and IL-10 immediately before and after primary PCI （ percutaneous coronary intervention ） in patients with ST-segment elevation myocardial infarction （ STEMI ） and explore the interaction of these cytokines.Methods A total of 59 STEMI patients were recruited.And their serum concentrations of IL-6,IL-8,MCP-1 and IL-10 were measured by ELISA before primary PCI and 4 -6 hours,12 hours,24 hours and 7 days postintervention.For each cytokine,the level at each time-point post-PCI was compared to that at pre-PCI.Correlation coefficient test was used to analyze the interactions of these four cytokines.Results At 12 hours post-PCI,the median serum levels of IL-6 and IL-8 were higher than those before PCI （ IL-6：8.51 ng/L vs 6.76 ng/L,IL-8：4.67 ng/L vs 2.95 ng/L,both P 〈0.05）.At 4 -6 hours and 12 hours post-PCI,the median values of MCP-1 were increasing significantly compared to those at pre-PCI （ 35.04 ng/L,34.24 ng/L vs 30.45 ng/L,both P 〈0.05 ） while those of IL-10 decreased （ 18.15 ng/L,18.82 ng/L vs 20.95ng/L,both P 〈0.05）.The levels of IL-6 and IL-10 at pre-PCI were associated with the Killip classification on admission （ 1L-6：r = 0.293,P 〈 0.05; IL-10：r = - 0.287,both P 〈 0.05 ）.Except for IL-8,other cytokines had no significant relation with the time length from onset to admission （P 〉 0.05 ）.Additionally,these four cytokines were not found to be related with the location and extension of myocardial infarction,ejection fraction and NT-proBNP.At each time-point,there were a positive relationship among the natural logarithms of the concentrations of IL-6,IL-8 and MCP-1 （ P 〈 0.01 ）,all of which were inverse to the natural logarithm of the concentration of IL-10 （P 〈 0.01 ）.Conclusions The pro-inflammatory cytokines increase while the anti-inflammatory cytokines decrease after myocardial ischemia/reperfusion.An imbalance of inflammatory cytokines may be present.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2011年第12期819-823,共5页
National Medical Journal of China
基金
国家重点基础研究发展计划＂973＂项目（2007CB512107）
关键词
心肌梗死
白细胞介素类
趋化因子
心肌再灌注
Myocardial infarction
Interleukins
Chemotactic factors
Myocardial reperfusion
