轻度冠状动脉微栓塞后TNF-α和cTnT的变化  

Expressions of Expression of Tumor Necrosis Factor-alpha and Troponin T in the Model of Mild Coronary Microembolization

作　　者：陈章炜[1] 钱菊英[1] 马剑英[1] 常书福[1] 贾剑国[1] 姚瑞民[1] 孙爱军[1] 邹云增[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院上海市心血管病研究所,上海200032

出　　处：《中国分子心脏病学杂志》2010年第5期310-313,共4页Molecular Cardiology of China

基　　金：国家自然科学基金(30671998和30901383);上海曙光追踪计划(06GG03)

摘　　要：目的冠状动脉微栓塞是急性冠脉综合征和冠心病PCI术后的不良后果,严重影响冠心病的预后。目前对早期发现和诊断冠脉微栓塞尚无较好的临床指标。本文通过检测轻度冠脉微栓塞后不同时间点TNF-α和cTnT的血清学水平,探索早期筛查冠脉微栓塞的血清学标志物。方法 12周龄健康小型猪8只,通过经皮冠脉介入法,于前降支中远端,经微导管注入微栓塞球(总计5万个,直径42μm)建立轻度冠状动脉微栓塞模型,微栓塞术前、术后2小时、6小时、1周分别采集股动脉血,以酶联免疫法(ELISA)法检测各时间点的血清TNF-α水平,以电化学发光法检测血清cTnT水平;术后1周时,处死动物,收集心肌组织标本,行四氮唑蓝染色,检测心肌梗死灶;对前壁、后壁心肌组织切片行HE染色,检测微梗死灶;同时以免疫组化法检测心肌组织中TNF-α的蛋白表达。结果与冠脉微栓塞术前(137.97±28.20pg/ml)相比,血清TNF-α在术后两小时即达到峰值(256.35±68.27pg/ml,P<0.01),术后1周(103.42±16.68pg/ml)降至术前水平,而一周时TNF-α前壁心肌组织表达高于后壁;cTnT在术后6小时才升至峰值水平(0.158±0.161ng/mlvs术前<0.01ng/ml,P<0.05),术后1周(0.041±0.053ng/ml)仍高于术前水平。心肌HE染色示,5万微球的冠脉微栓塞不足以引起心肌微梗死灶的形成。结论相比于血清cTnT,轻度冠状动脉微栓塞后血清TNF-α水平更早达到峰值;cTnT虽然达峰偏晚,但持续时间可达一周左右,二者结合对早期发现和诊断冠脉微栓塞起重要作用。Objective In order to support the clinical diagnose of early coronary microembolization（CME）,our study was designed to analyze the serum levels of tumor necrosis factor-alpha（TNF-α） and troponin T（cTnT） after mild CME in pigs.Methods Eight minipigs of either sex were subjected to mild CME by injection of 42μm microspheres with a total number of 50,000.The serum levels of TNF-α and cTnT were detected by the method of ELISA and immunoturbidimetry at different time points.The myocardial expression of TNF-α was also detected by immunohistochemistry at one week after CME.Results Compared with the base level of TNF-α（137.97±28.20pg/mL）,TNF-α reached the peek level at 2nd hour（256.35±68.27pg/mL） after CME,which was decreased significantly at one week after CME.Although the serum level of cTnT reached the peek level（0.158±0.161ng/ml） at 6th hour after CME,its level at one week（0.041±0.053ng/ml） was still higher than the base level.The results of immunohistochemistry also demonstrated significant enhancement of TNF-α in anterior myocardial wall,which further proved the higher expression of TNF-α after mild CME.Conclusion Detecting the serum levels of TNF-α and cTnT might play an important role in the early diagnosed of coronary microembolization.

关 键 词：冠状动脉微栓塞 肿瘤坏死因子 肌钙蛋白 

分 类 号：R541.4[医药卫生—心血管疾病]