【摘要】 目的探究心肌梗死合并肺部感染患者血清降钙素原(PCT)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)与心肌酶谱的关系及临床价值。方法选取2017年6月至2019年6月南阳市中心医院收治的急性心肌梗死患者160例(心梗组)作为研究对象,根据是否合并肺部感染分为合并感染组(n=42)和单纯心梗组(n=118),另选同期体检的健康人群80例作为对照组。检测所有受试者血清PCT、IL-6、TNF-α、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK)及肌酸激酶同工酶(CKMB)水平,采用pearson相关分析急性心肌梗死合并肺部感染患者血清PCT、IL-6、TNF-α与心肌酶谱的关系,采用受试者工作特征(ROC)曲线分析血清PCT、IL-6及TNF-α水平对心肌梗死合并肺部感染患者的诊断价值。结果心梗组患者血清PCT、IL-6、TNF-α、AST、LDH、CK及CKMB水平均显著高于对照组,差异有统计学意义(P<0.05)。合并感染组患者血清PCT、IL-6、TNF-α水平明显高于对照组,差异有统计学意义(P<0.05)。pearson相关分析结果显示,在急性心肌梗死患者合并肺部感染患者体内,血清PCT、IL-6、TNF-α与AST、LDH、CK、CKMB均呈现显著正相关关系(P<0.05);ROC曲线分析结果显示,PCT、IL-6、TNF-α水平对于诊断急性心肌梗死患者合并肺部感染均有一定的价值(P<0.05),PCT+IL-6+TNF-α联合检测的AUC、灵敏度与准确度均高于PCT、IL-6及TNF-α单独检测(P<0.05)。结论急性心肌梗死合并肺部感染患者血清PCT、IL-6和TNF-α呈高表达水平,与血清心肌酶谱呈现一定正相关关系,且血清PCT、IL-6和TNF-α联合检测可提高急性心肌梗死患者的肺部感染检出率。更多还原

【Abstract】 Objective To explore the relationship between serum procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) and myocardial enzyme spectrum in patients with myocardial infarction and pulmonary infection.Methods From June 2017 to June 2019,160 patients with acute myocardial infarction(MI group) in Nanyang Central Hospital were selected as the study objects.According to whether they were combined with pulmonary infection,they were divided into two groups:the combined infection group(n=42) and the single MI group(n=118).Another 80 healthy people who had experience in our hospital at the same time were selected as the control group.The levels of serum PCT,IL-6,TNF-α,AST,LDH,CK and CKMB were measured in all subjects.The relationship between serum PCT,IL-6,TNF-α and myocardial enzymes in patients with acute myocardial infarction and pulmonary infection was analyzed by Pearson correlation.The working characteristic curve of subjects was used to analyze the effects of serum PCT,IL-6 and TNF-α levels on myocardial infarction and the diagnostic value of pulmonary infection.Results The levels of PCT,IL-6,TNF-α,AST,LDH,CK and CKMB in the MI group were significantly higher than those in the control group(P<0.05).The serum levels of PCT,IL-6 and TNF-α in the patients with infection were significantly higher than those in the control group(P<0.05).There was no significant difference in sex ratio,age,smoking history,drinking history,serum AST,LDH,CK and CKMB between the two groups(P>0.05).Pearson correlation analysis showed that in patients with acute myocardial infarction and pulmonary infection,serum PCT,IL-6,TNF-α and AST,LDH,CK,CKMB all showed significant positive correlations(P<0.05).The ROC curve showed that the levels of PCT,IL-6,and TNF-αhad certain value in the diagnosis of pulmonary infection in patients with acute myocardial infarction(P<0.05).The AUCof PCT+IL-6+TNF-α sensitivity and accuracy of combined detection were higher than those of PCT,IL-6 and TNF-α alone(P<0.05).Conclusion Serum PCT,IL-6 and TNF-α are highly expressed in patients with acute myocardial infarction complicated with pulmonary infection,which were positively correlated with serum myocardial enzyme spectrum,and the combined detection of serum PCT,IL-6 and TNF-α could improve the accuracy of diagnosis for pulmonary infection in patients with acute myocardial infarction.更多还原