【作者】 李明哲；

【导师】 赵利华；

【作者基本信息】 吉林大学 ， 内科学， 2009， 硕士

【摘要】 本文旨在观察急性心肌梗死(AMI)患者行急诊经皮冠状动脉介入治疗(PCI)术前后细胞因子IL-6浓度变化与无复流关系,探讨其可能机制。选择于发病12h内接受急诊PCI治疗,术后造影显示TIMI3级血流的AMI患者42例。分为二组:无复流组,冠状动脉成形术后2小时抬高最显著导联ST段回落<50%;再灌流组,冠状动脉成形术后2小时抬高最显著导联ST段回落≥50%。所有病例均于PCI术前及术后24h、48h从肘静脉采血3毫升,置于试管中(不加抗凝剂),立即以3000r/min,离心10min,然后吸取上层血清置于试管中。密封试管并将采集的标本于-70℃冰箱保存待测。应用双抗夹心ELISA法检测急诊PCI术前、术后24小时、48小时血IL-6浓度。计量资料数据分析应用t检验、方差分析或秩和检验,计数资料采用X2检验,P<0.05为有统计学意义。无复流组与再灌注组术后各时间点IL-6水平组间相互比较存在显著性差异,无复流组明显高于再灌注组(P<0.05),二组IL-6水平术后24h、48h水平与术前比较均有明显增高(P<0.05);且无复流组IL-6回落明显延迟,术后48h仍未有回落趋势,而再灌流组术后48h IL-6水平较术后24h有所回落,但未见统计学差异。从实验结果我们可以看出:AMI患者急诊PCI术后高IL-6水平,尤其是术后48小时IL-6浓度,可作为诊断无复流的辅助检查;无复流组AMI患者术后严重心律失常发生率偏高,左室射血分数偏低;IL-6的促炎、促凝作用可能是导致AMI患者PCI后无复流的主要机制。更多还原

【Abstract】 Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality in most industrialized nations throughout the world. Options for myocardial revascularization include thrombolysis or percutaneous coronary intervention (PCI) in the early period after AMI, or coronary artery bypass grafting (CABG) for suitable patients. It has commonly been suggested that surgery in the early period after AMI can be associated with increased morbidity and mortality. early surgical revascularization is beneficial in 90% patients who have mechanical complications, ongoing ischemia, and cardiogenic shock complicating AMI. However, there are certain amount patients even undergoing PCI, they still presented no reflow phenomenon, which induced instantly or longterm prognosis mala, especially in the patients with cardiac shock and anterior wall myocardial infarction. Since 1974 Kloner primarily proposes no relow, many researchers had conducted extensively and penetrating investigations about its pathogenesis, risk factors, diagnosis and treatment in the lab and clinic. Presently there are no effective biochemistry index for the prediction and diagnosis of no reflow phenomenon. Numerous studies indicated there were many mechanisms involved in this phenomenon. Such as (1) micrangiophraxis induced by endothelium ischemia injury, (2) platelet and cellulose occlusion in the cardiac micrangium, (3) white cell occlusion, (4) the formation of atherosclerotic plaque, fragments, clot and platelet thromus, (5) activation of neutrophil, production of oxygen free radical and so on. Even though , the mechanism of NR has been extensively reported, the effect of inflammatory factor in the occurrence of NR rarely reported. Inflammatory factors are those factors produced by inflammatory cell and involved in the inflammatory reactions. IL-6 is an acute inflammatory cytokines, play a key role in the inflammatory reactions, which could improve the occurrence of inflammatory actions and thrombosis. IL-6 could recruit neutrophil, increase the adhesion of neutrophil to blood vessel endotheliums, increase the production of fibrinogen in liver, increase the synthesis and aggregation of platelet, etc. All those effects are also involved in the occurrence of NR phenomenon. Therefore, IL-6 might play a key role in the NR phenomenon and be considered as a biochemistry index for the prediction and diagnosis of NR. In the present study, we were attempted to observe the IL-6 level at all time point and explore the influence of IL-6 in the instant and near future prognosis and find its possible mechanisms. The present study might provide a new thought and method for the diagnosis and treatment of AMI in clinic.Objective To observe the cytokine IL-6 levels at different time of PCI preoperation and post-operation, explore the influence of this cytokine for the near future prognosis and approach its mechanism.Material and Method 1. Seclection of clinical case and experimental design: Acute AMI patients with ST segment elevation successfully treated by PCI within 12 h of onset were selected in the cardiovascular internal medical department in First Hospital of Jilin University from Feb. 2008 to Feb. 2009, and coronary arteriongraphy showed Thrombol ysis In Myocardial Infarction (TIMI) grade 3 blood flow after operation. 42 patients fitting in this condition were selected according to the analysis of clinical and intervention information. The subjects were divided into two groups, according to 50% resolution of ST segment elevation within 2h of coronary arterioplasty. Patients with ST segment elevation resolution less than 50% were considered as no reflow group (n=19). Patients with ST segment elevation resolution more than 50% were considered as reflow group (n=23). 2. sample collection and detection: all selected subjects were undergo intravenious haemospasia 3ml, the serum was collected after 3000 rpm for 10 min, stored in -70℃.ELISA was used for the detection of IL-6.Result The IL-6 levels at all times of post-operation have significant difference in the non reperfusion group and reperfusion group. Moreover, the IL-6 levels all obviously increased at 24h and 48h after operation in both groups (P<0.05). IL-6 level in the no reflow group decreased slowly, even after 48h of operation, it still didn’t decreased. However, the IL-6 levels in reflow group started decrease slightly after 24 h of operation, but no significant difference.Conclusion 1. High IL-6 levels in the blood of AMI patient after emergency PCI surgery could be considered as screening index of no reflow(especially at 48h of post-operation). 2. the incidence rate of serious cardial arrhythmias and cardiac incompetent at the duration of hospital stay was high at no relflow AMI patient. 3. enhancement of inflammatory reaction and thrombosis by IL-6 might be the mechanism inducing no reflow phenomenon of PCI postopertion patients.更多还原