急性冠脉综合征患者炎性因子的表达与室性心律失常的关系  

Relationship Between the Expression of Inflammatory Factors in Patients with Acute Coronary Syndrome and Ventricular Arrhythmia

作　　者：谢勇[1] 孟素荣[1] 邓春凤[1] 彭健[1] 李若[1] 刘福强[1] 

机构地区：[1]南方医科大学附属南方医院心内科,广东广州510515

出　　处：《医学临床研究》2011年第6期1099-1101,1104,共4页Journal of Clinical Research

摘　　要：【目的】探讨急性冠脉综合征（ACS）患者的炎性因子的表达与室性心律失常的关系。【方法】本院115名确诊为ACS的患者其中，ST段抬高型心肌梗死（STEMI）54例，非ST段抬高型心肌梗死（NSTEMI）22例，不稳定型心绞痛（UA）39例。分别在入院时、7d、14d抽静脉血测定CD40配体（CD40L）、肿瘤坏死因子（TNF-α）、白介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、白细胞（WBC）。入院后5d之内行动态心电图检查，并予Lown分级。出院后随访3个月。【结果】住院期间患者发生室性心律失常的Lown分级越高，炎性因子的表达越高，成正相关关系。sTEMI患者的TNF-α、IL一6、hs—CRP、WBC显著高于NsTEMI和uA组（P均〈0．01），而cD40L在NsTEMI组的表达显著高于sTEMI组及uA组，同时sTEMI组高于UA组（P均〈0．01）。炎性因子CD40L、TNF—α、IL-6、hs—CRP、WBC与ACS后室性心律失常的发生的Lown分级成正相关的关系。随访3个月，有6例患者死于恶性心脏事件，此6例死亡患者入院时的CD40L显著高于其他患者。【结论】急性冠脉综合征后患者室性心律失常的发生与炎性因子的表达增高有关。ACS后室性心律越严重，炎性因子的表达水平越高。[Objective]To explore the relationship between the expression of inflammatory factors in pa- tients with acute coronary syndrome（ACS） and ventricular arrhythmia. [Methods] A total of 115 patients diagnosed as ACS in our hospital were enrolled in this study. Among all patients, 54 patients were ST-segment elevation myocardial infaretion（STEMI）, and 24 patients were non-ST-segment elevation myocardial infarction （NSTEMI）, and 39 patients were unstable angina（UA）. Blood samples were collected on admission , 7d and 14d after admission to determine serum levels of CD40 ligand（CD40L）, tumor necrosis factor-alpha（TNF-a）, interleukin-6（IL-6）, high sensitivity C-reactive protein（hs-CRP） and white blood cell （WBC）. Dynamic electrocardiogram was performed and Lown grade was taken within 5 days after admission. After discharge, pa- tients were followed up for 3 months. [Results] The expression of inflammatory factors increased with the rising of Lown grade of ventricular arrhythmia after ACS in hospital stay, and there was positive correlation between them. TNF-α, IL-6, hs-CRP and WBC in STEMI group were significantly higher than those in NSTEMI and UA groups（all P〈0.01）. CD40L in NSTEMI group was markedly higher than that in STEMI and UA groups, and that in STEMI group was higher than that in UA group（all P 〈0.01）. Correlation analysis showed that inflammatory factors such as CD40L, TNF-α, IL-6, hs-CRP and WBC were positively related with the Lown grade of ventricular arrhythmia after ACS. During 3-month follow up, 6 patients died of malignant cardiac events. CD40L of these deceased patients was markedly higher than that of other patients. [Conclusion]The incidence of ventricular arrhythmia in ACS patients is correlated with the high expression of inflammatory factors. The expression of inflammatory factors increases with the severity of ventricular arrhythmia.

关 键 词：冠状动脉疾病 急性病 心律失常 

分 类 号：R543.3[医药卫生—心血管疾病]