急性心肌梗死时肿瘤坏死因子-α表达与室性心律失常的关系  

Relationship between TNF-α and ventricular arrhythmias in acute myocardial infarction （AMI）

作　　者：肖华[1] 陈志坚[1] 廖玉华[1] 程翔[1] 刘坤[1] 王敏[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心内科,武汉430022

出　　处：《中华急诊医学杂志》2008年第12期1292-1295,共4页Chinese Journal of Emergency Medicine

基　　金：国家重点基础研究发展计划（973计划）资助项目（2007CB512000;2007CB512005）;国家自然科学基金资助项目（30770880）

摘　　要：目的研究急性心肌梗死时肿瘤坏死因子-α（TNF-α）表达与心肌梗后室性心律失常发生之间的关系，并初步探讨其机制。方法采用临床和动物实验相结合的方法。（1）临床研究选择2005年5月至2006年11月华中科技大学同济医学院附属协和医院CCU住院的急性心机梗死患者80例，依据WHO诊断标准：持续典型的胸痛30min以上、典型心电图动态变化、心肌酶CK／CK-MB和／或TNT的升高且动态变化，具有以上任何两项可确诊。排除合并感染性疾病如严重的上呼吸道感染、肺部和胆道感染等，高热、肿瘤等情况。在不同时间点检测TNF-α表达水平和室性心律失常发生情况，进行直线相关性分析。（2）动物实验采用大鼠离体心脏灌流模型观察TNF-α致室性心律失常的作用。通过激光共聚焦技术检测心肌细胞胞内钙荧光强度以观察TNF-α对单个心肌细胞胞内钙浓度的影响。数据处理采用SPSS13．0统计软件，组间均数比较用SNK-q检验。结果心肌梗死患者TNF-α表达与心肌梗后室性早搏Lown分级呈正相关，急性前壁心肌梗死患者TNF-α的水平（46．41±10．34）pg/ml较其他部位心肌梗死高（28．25±6．35）pg／ml（P〈0．05）。不同浓度的TNF-α灌流能够引起离体大鼠心脏室性心律失常，且室性心律失常发生次数随TNF-α浓度的增加而增多；经2mg／kg依那西普（TNF-α受体螯合剂）预处理后同等浓度的TNF-α引起的室性心律失常较前明显的减少（P〈0．05）。浓度为200U／ml的TNF-α可使心肌细胞胞内钙荧光强度短时间内增加（121．0±13．3）％；依那西普预处理后，同等浓度的TNF-α仅能使胞内钙荧光强度增加（13．5±3．7）％（P〈0．05）。结论临床研究证实急性心梗患者TNF-α表达与室性心律失常发生具有相关性。动物实验证实离体心脏灌流TNF-α具有致室性心律失常的作用。总之，急性心肌梗死后Objective To investigate the relationship between TNF-α and ventricular arrhythmias after acute myocardial infarction （AMI） and its mechanism. Method Both the clinical and animal experiments were done. （1） Clinical experiment： Eighty patients with AMI were included in Union Hospital, Tongji Medical College, Huazhong University of Science and Techology, from May 2005 to November 2006 according to the WHO diagnostic criteria. Co-infection of diseases such as severe upper respiratory infection, lung infection, high fever, cancer, et al were excluded. The relationship between the levels of TNF-α and arrhythmias were observed at different times after AMI. A straight line correlation analysis was done. （2） Animal experiment： Different concentrations of TNF-α were added to isolated rat hearts for observing the arrhythmia effects. The effect of TNF-α on intracellular Ca^2＋ concentration was detected by laser confocal technique. All data were analyzed by SNK- q test using SPSS 13.0 sofeware program. Results （1） The plasma levels of TNF-α were significantly associated with the Lown class of PVC after AMI are they were higher in AMI of anterior wall [（46.41 ±10.34） pg/ml] than other positions [ （28.25± 6.35） pg/ml, P 〈 0.05]. 2） The frequency of ventricular arrhythmias was interrelated with the concentrations of TNF-α. Using etanereept beforehand,TNF-α induced a slight increase of intracellular Ca^2＋ intensity （ P 〈 0.05）. Conclusions There was a relationship between TNF-α levels and ventricular arrhythmias in patients with AMI. Animal experiments confirmed the isolated heart perfusion with TNF-α induced ventficular arrhythmias. Expression of TNF-αafter AMI was related with the occurrence of ventricular arrhythmias. The effect might be associated with the increased intracellular Ca^2＋ intensity caused by TNF-α.

关 键 词：急性心肌梗死 肿瘤坏死因子-Α 室性心律失常 离体心脏灌流 激光扫描共聚焦显微镜 

分 类 号：R542.22[医药卫生—心血管疾病] R587.1[医药卫生—内科学]