【摘要】 目的近年来,对冠心病的病理生理学的认识有了明显的转变,认为动脉粥样硬化(atherosclerosis,AS)是主动的炎症性过程,而不是单纯的脂质被动浸润。文中探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者血清中白介素-6(interleukin-6,IL-6)、IL-10、IL-6/IL-10、肿瘤坏死因子(tumor necrosis factor,TNF)-α及超敏C反应蛋白(hyperseneitiveC-reactive protein,hsCRP)水平变化及意义。方法选自2010年10月至2011年1月189例行冠状动脉造影术(coronary an-giography,CAG)者,其中129例冠状动脉造影阳性者为ACS组,包括急性心肌梗死(acute myocardial infarction,AMI)组66例,不稳定性心绞痛(unstable angina,UA)组63例,另60例冠状动脉造影阴性者为对照组。所有患者均采用ELISA法测定血清IL-6、IL-10、IL-6/IL-10、TNF-α及hsCRP水平。结果 ACS组血清IL-6水平明显高于对照组(ACS:6.38±2.52 ng/L vs 1.62±1.71 ng/L,P<0.01),各亚组间进一步比较(AMI:4.84±8.74 ng/L,UA:2.57±2.87 ng/L,对照:1.62±1.71 ng/L,3组间比较,P<0.05);IL-10均高于对照组(AMI:17.56±2.08 ng/L,UA:16.84±2.74 ng/L,对照:15.69±1.78 ng/L,P<0.05),但AMI和UA2组间无明显差异。IL-6/IL-10比值高于对照组(AMI:0.27±0.48ng/L,UA:0.22±0.17ng/L,对照:0.10±0.09ng/L,P<0.05);TNF-α高于对照组(AMI:44.56±30.62 pg/ml,UA:41.12±24.34 pg/ml,对照组:28.61±17.52 pg/ml,P<0.05),但AMI与UA间无明显差异;hsCRP明显高于对照组(AMI:25.5±29.5 mg/L,UA:9.93±11.05 mg/L,对照:4.02±4.29 mg/L,P<0.05);ACS患者中,IL-6与hsCRP成正相关,(r=0.395,P<0.05);IL-6与TNF成正相关,(r=0.249,P<0.05)。结论 IL-6/IL-10、TNF-α及hsCRP水平变化和ACS具有一定的相关性,可能对其斑块的不稳定性具有预测价值。更多还原

【Abstract】 Objective Recent views hold atherosclerosis to be an active inflammatory process rather than a simple lipid infiltration.This study was to investigate the changes in the levels of serum IL-6,IL-10,IL-6/IL-10,TNF-α and HsCRP and their implications in patients with acute coronary syndrome(ACS).Methods A total of 189 patients undergoing coronary angiography(CAG) were assigned to a control group(n=60) and an ACS group(n=129) according to the results of CAG,the latter including 66 cases of acute myocardial infarction(AMI) and 63 cases of unstable angina(UA).The levels of serum IL-6,IL-10 and TNF-α were measured by ELISA,and that of HsCRP determined by immunityturbidimetry.Result The level of serum IL-6 was significantly more activated in the ACS group(6.38±2.52 ng/L,P<0.01) as well as in the subgroups of AMI(4.84±8.74 ng/L) and UA(2.57±2.87 ng/L) than in the control group(1.62±1.71 ng/L,P<0.05).So was the level of IL-10 in the AMI(17.56±2.08 ng/L) and UA patients(16.84±2.74 ng/L) than in the controls(15.69±1.78 ng/L,P<0.05),but with no significant difference between AMI and UA(P>0.05).The ratio of IL-6/IL-10 was significantly higher in the AMI(0.27±0.48 ng/L) and UA patients(0.22±0.17 ng/L) than in the controls(0.10±0.09 ng/L,P<0.05).So was the level of TNF-α(44.56±30.62 pg/ml and 41.12±24.34 pg/ml vs 28.61±17.52 pg/ml,P<0.05),but with no significant difference between AMI and UA(P>0.05).The same was true for the level of HsCRP(25.5±29.5 mg/L and 9.93±11.05 mg/L vs 4.02±4.29 mg/L,P<0.05).In the ACS patients,the level of serum IL-6 was positively correlated with that of HsCRP(r=0.395,P<0.05) and that of TNF(r=0.249,P<0.05).Conclusion Changes in the levels of L-6/IL-10,TNF-α and HsCRP are correlated with ACS,and may have a predictive value for its plaque instability.更多还原