PCI对冠心病患者血清hsCRP、IL6、oxLDL的影响.doc

PCI对冠心病患者血清hs-CRP、IL-6、ox-LDL的影响【摘要】 目的：观察PCI对冠心病患者血IL-6、hs-CRP、ox-LDL的影响，探讨IL-6、hs-CRP、ox-LDL与冠脉病变程度的相关性。方法：对94例冠心病患者行冠状动脉造影(SCAG)，按SCAG结果分为PCI组67例和对照组27例，两组均于术前及术后4小时取肘静脉血，测定血清hs-CRP、IL-6及ox-LDL水平。结果：与术前比较，PCI组术后血清hs-CRP水平显著增高(P<0.05)，IL-6、ox-LDL水平差异无统计学意义(P>0.05);与对照组比较，PCI组术前、术后血清hs-CRP、IL-6、ox-LDL水平差异均有统计学意义(P<0.05)。多支及双支病变组术前和术后血清hs-CRP水平显著高于单支病变组(P<0.05);多支病变组术前和术后IL-6水平显著性高于双支和单支病变组(P<0.05);三组间ox-LDL水平差异无统计学意义(P>0.05)。弥漫病变组和长病变组血清hs-CRP、IL-6水平明显高于局限病变组，差异有统计学意义(P<0.05);血清ox-LDL水平各组间比较，差异无统计学意义(P>0.05)。结论：炎症因子与ox-LDL对CHD的诊断、危险性预测具有临床价值。CHD患者血清IL-6、hs-CRP水平与冠脉病变程度存在相关性。 【关键词】 冠心病PCIIL-6hs-CRPox-LDLAbstractObjective:To observe the effect of percutaneous coronary internvention(PCI) on the serum levels of hs-CRP,IL-6 and ox-LDL in patients with coronary heart disease(CHD) and to analyze the relationship between their levels and the severity of CHD.Methods:Selective coronary angiography was performed in 94 CHD patients.Angiographic images showed that CHD patients with one-vessel,two-vessel,and multi-vessel stenosis and showed long,diffuse,and local lesions.The patients were divided into PCI group (67 patients) and control group (27 patients) by different angiographic results.Blood samples were harvested in 4 hours after treatment and serum hs-CRP,IL-6 and ox-LDL levels were measured.Results:Compared to those before treatment,hs-CRP was significantly increased in the PCI group(P<0.05),while IL-6 and ox-LDL did not differ(P>0.05);compared to those in the control group,hs-CRP,IL-6,and ox-LDL were markedly different both before and after treatment(P<0.05).Both before and after treatment,CHD patients with two- and multi-vessel stenosis had higher hs-CRP level than those with one-vessel did(P<0.05);those with multi-vessel stenosis had higher IL-6 level than those with one- or two-vessel stenosis(P<0.05);no difference was noted in ox-LDL level among the 3 groups.CHD patients with diffuse and long lesions had increased hs-CRP and IL-6 as compared to those with local lesions(P<0.05);ox-LDL did not differ among the 3 groups(P>0.05).Conclusion:PCI may be effective to improve the levels of hs-CRP,IL-6 and ox-LDL and these factors are related to the severity of CHD.Key wordscoronary heart diseasepercutaneous coronary interventionIL-6hs-CRPox-LDL一般认为，冠状动脉性心脏病(coronary artery heart disease,CHD)的发生与发展与炎症反应密切相关，高敏C反应蛋白(hs-CRP)为CHD独立危险因子;IL-6促进血管内皮细胞和血管平滑肌细胞(VSMC)的增生，参与冠状动脉硬化的形成和发展。研究1证实，氧化低密度脂蛋白(ox-LDL)可诱导动脉粥样硬化斑块内泡沫细胞形成，是动脉粥样硬化发生、发展的独立危险因子。本研究对94例冠心病患者进行冠状动脉造影(SCAG)，其中67例经皮冠状动脉介入治疗(PCI)，观察PCI对冠心病患者血IL-6、hs-CRP、ox-LDL的影响，探讨IL-6、hs-CRP、ox-LDL与冠脉病变程度的相关性。1临床资料2009年7月11月参照内科学第6版“CHD诊断标准”2拟诊为CHD住院患者94例，入院后行SCAG，其中67例SCAG阳性患者接受同步PCI(PCI组)，男 46 例，女21例，年龄4685岁，平均(61.410.9)岁，病程1个月10年，平均5.5年;67例中合并高血压病41例，糖尿病8例。 SCAG阴性27例(对照组)，男13 例，女14例，年龄4475岁，平均(61.310.8)岁，病程2个月4.5年，平均3.6年;27例中合并有高血压病20例，合并陈旧性脑梗死4例，糖尿病3例。PCI组患者在冠状动脉主要病变血管实施PTCA及支架置入。PCI组患者均为急性心肌梗死发病后1周或心绞痛发作稳定5天以上，且无急性感染证据。两组患者性别、年龄、病程等资料均衡，具有可比性。2方法2.1PCI采用Judkins法作选择性冠脉造影，由两位以上有经验的专科医师进行SCAG结果分析和判定。2.2观察指标及方法两组患者手术前日、术后4小时取肘静脉抽血，离心取血清-70冰箱储存，酶联免疫吸附反应法(ELISA法)测定IL-6、hs-CRP、ox-LDL浓度。2.3统计学方法计量资料以(s)表示，采用t检验，单因素方差分析。3结果3.1SCAG前后两组IL-6、hs-CRP、ox-LDL水平比较PCI组术后与术前比较，血清hs-CRP水平显著增高(P<0.05)，IL-6、ox-LDL水平差异无统计学意义(P>0.05);与对照组比较，PCI组术前、术后血清hs-CRP、IL-6、ox-LDL水平差异均有统计学意义(P<0.05)，见表1。表1两组血清IL-6、hs-CRP、ox-LDL水平比较3.2PCI组SCAG前后不同冠脉病变支数IL-6、hs-CRP、ox-LDL水平比较根据冠脉病变支数将PCI组患者分为单支病变组32例、双支病变组21例、多支病变组14例。多支病变组、双支病变组术前、术后血清hs-CRP水平显著高于单支病变组(P<0.05);多支病变组术前和术后IL-6水平显著高于双支病变组和单支病变组(P<0.05);三组间ox-LDL水平比较，差异无统计学意义(P>0.05)，见表2。表2PCI组不同病变支数hs-CRP、IL-6、ox-LDL水平比较3.3PCI组SCAG后不同冠脉病变IL-6、hs-CRP、ox-LDL水平比较按病变狭窄的长度将SCAG阳性67例患者分局限病变(10mm)20例，长病变(10mm<病变狭窄长度20mm)23例;弥漫病变(>20mm)24例。血清hs-CRP、IL-6水平随着病变狭窄长度的增加而升高，血清ox-LDL水平组间差异无统计学意义(P>0.05)，见表3。表3PCI组SCAG后不同冠脉病变血清hs-CRP、IL-6、ox-LDL水平比较4讨论研究表明，CRP、IL-6作为评估CHD患者预后的独立因子，可作为预测是否发生心血管事件的重要预测因子3,4。在冠状动脉的慢性炎症中，CRP大量产生并活化炎症细胞，后者通过直接浸润、聚集或间接产生细胞因子作用，引起血管内皮受损5。相关研究也证实，IL-6与CHD的预后关系密切6。ox-LDL由LDL 在体内氧化形成，是动脉粥样硬化发生、发展乃至不稳定斑块形成的关键因子。研究显示7，PCI显著增加CHD患者术后血清hs-CRP水平，且冠状动脉病变越复杂，术后血清Hs-CRP水平升高越明显。本研究结果与其一致。PCI治疗后血清hs-CRP水平增高的可能机制为PCI中球囊扩张阻断血流，内膜机械撕裂及斑块挤压破裂所致。故hs-CRP可以预测CHD患者的预后，对PCI术后并发症的防治具有一定的指导意义。血清hs-CRP、IL-6水平检测，对于评估患者冠脉病变狭窄程度、病变支数具有临床参考价值。【参考文献】 1王群山,陆国平.ox-LDL抗体的检测与动脉粥样硬化J.国外医学心血管疾病分册,2003,30(1):225-227.2叶任高.内科学M.第6版.北京：人民卫生出版社,2003.451-452.3Virmani R,Burke AP,Farb A,et al.Pathology of thevulnerable plaqueJ.J Am Coll Cardiol,2006,47(8Suppl):C13-18.4Goldstein JA,Chandra HR,ONeillWW.Relation ofnumber of complex coronary lesions to serum C-reac-tive protein levels and major adverse cardiovascularevents at one yearJ.Am J Cardio,2005,96(1):56-60.5李晓阳,郭学青.C反应蛋白J.河北医学,2002,8(9):856.6Lindmark E,Diderhol ME,Wallentin L,et