经皮冠状动脉腔内成形术与冠脉内支架安放术前后血清白细胞介素6、肿瘤坏死因子α水平的变化  

Elevations of serum interleukin-6 and tumor necrosis factor-α after percutaneous transluminal coronary angioplasty

作　　者：王光公[1] 孔宪明[2] 陈纪林[3] 刘海波[3] 杨朝宽[1] 

机构地区：[1]河南省人民医院二内科,河南郑州450003 [2]山东医科大学,山东济南250012 [3]北京阜外医院,北京100037

出　　处：《河南医学研究》2000年第3期232-235,共4页Henan Medical Research

摘　　要：目的 :探讨冠脉成形术引起早期炎性反应的机制。方法 :观察 3 7例冠脉成形术病人术前及术后 4小时血清白细胞介素 6(IL -6)、肿瘤坏死因子α(TNF -α)水平。对成形术中球囊阻断冠脉引起的缺血的强度进行量化。结果 :有侧支循环者 (有侧支循环组 ,n =10 )与无侧支循环者 (无侧支循环组 ,n =2 7)术前IL -6、TNF -α无显著差异 (P >0 0 5 )。有侧支循环组与无侧支循环组术后 4小时IL -6、TNF -α水平均显著高于术前。有侧支循环组术后IL -6、TNF -α显著低于无侧支循环组。从手术情况看 ,有侧支循环组缺血强度低于无侧支循环组 ,机械损伤则大于无侧支循环组。等级相关分析显示 ,冠脉成形术后IL -6、TNF -α水平升高幅度之间 ,以及升高幅度与缺血强度之间相关性良好 (P均 <0 0 1)。结论 :IL -6、TNF -α是反映PTCA术后早期炎性反应的敏感指标。PTCA诱发早期炎性反应的主要机制为术中球囊操作造成的心肌缺血 /再灌注。Objective: To investigate the mechanism underlying the early inflammatory response after PTCA. Methods: The serum levels of IL-6、TNF-α were measured before and 4 hours after PTCA by‘sandwich'double-epitope ELISAs in 37 patients.The extent of myocardial ischemia induced by balloon inflation were quantified by a scoring system referring to the leaman coronay score. Results: The levels of IL-6、TNF-α in the patients with (collateral group,n=10) or without(non-collateral group,n=27)collateral circulation were similar before PTCA.Four hours after PTCA,both groups had a higher level of IL-6(19.629±2.225 pg/ml VS 9.308±11.934 pg/ml,31.038±1.678 pg/ml VS 9.700±1.837 pg/ml,respectively)and TNF-α (59.337±±1.633 pg/ml VS 27.183±2.103 pg/ml,87.135±1.492 pg/ml VS 26.873±1.945 pg/mg,respectively).IL-6、TNF-α levels after PTCA in the non-collateral group were also significantly highter than those of the collateral group.The collateral group had a higher mechanic injury and a lower ischemia stimulation.The results of rank correlation showed the elevations of IL-6、TNF-α after PTCA in the non-collateral group correlated well.Both the elevations of IL-6 and TNF-α correlated well with the extent of ischemia. Conclusion: IL-6、TNF-α are sensitive resembles of the early inflammatory response after PTCA;Myocardial ischemia reperfusion injury is the main mechanism underlying the early inflammatory response after PTCA.It is necessary to reduce the ischemia stimulation during PTCA.

关 键 词：经皮冠状动脉腔内成形术 侧支循环 IL-6 TNF-α 

分 类 号：R654.2[医药卫生—外科学]