急性心肌梗死患者血巨噬细胞移动抑制因子的变化及临床意义  

Changes of plasma macrophage migration inhibitory factor level in patients with acute myocardial infarction and its clinical significance

作　　者：邓湘宁[1] 王新宇[1] 于海奕[1] 陈少敏[1] 张幼怡[1] 杜晓军 高炜[1] Deng Xiangning;Wang Xinyu;Yu Haiyi;Chen Shaomin;Zhang Youyi;Du Xiaojun;Gao Wei(Department of Cardiology,Peking University Third Hospital and Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides,National Health and Family Planning Commission,Beijing Key Laboratory of Cardiovascular Receptors Research,Beijing 100191,China)

机构地区：[1]北京大学第三医院心血管内科,卫生计生委心血管分子生物学与调节肽重点实验室,心血管受体研究北京市重点实验室,100191

出　　处：《中国心血管杂志》2018年第2期104-109,共6页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金项目(81370317);北京大学临床研究项目(PUCRP201104)~~

摘　　要：目的探讨血浆巨噬细胞移动抑制因子(MIF)水平在急性ST段抬高型心肌梗死(STEMI)患者的变化及与预后的关系。方法入选2012年9月至2014年3月于北京大学第三医院接受急诊经皮冠状动脉介入治疗(PCI)的STEMI患者204例,分别于就诊时、PCI术后24 h及72 h采血测定血浆MIF水平,另选年龄、性别匹配的稳定性心绞痛(SAP)患者30例、健康体检者65名作为对照。收集STEMI患者的临床资料并进行长期随访。结果与对照组相比,STEMI患者就诊时血浆MIF水平即显著升高[53.1(36.4,81.9)ng/ml,P<0.001],并可持续至术后24 h和72 h(F=1.110,P=0.331)。STEMI患者就诊时MIF水平与肌酸激酶同工酶-MB和高敏肌钙蛋白T峰值呈正相关(r=0.439和0.316,均为P<0.001),与急性期左心室射血分数呈负相关(r=-0.338,P<0.001);就诊时、PCI术后24 h血浆MIF水平与高敏C反应蛋白相关(r=0.173,P=0.018;r=0.148,P=0.039);术后24 h血浆MIF水平与就诊时、PCI术后24 h和72 h的外周血单核细胞计数呈正相关(r=0.305、0.195和0.237,均为P<0.05);术后72 h血浆MIF水平与PCI术后24 h和72 h的外周血单核细胞计数呈正相关(r=0.175和0.146,均为P<0.05)。就诊时MIF高水平(≥53.1 ng/ml)的STEMI患者随访36个月发生不良心脑血管事件的风险是低水平组的2.4倍(95%CI:1.12~5.20,P=0.025)。结论 STEMI患者发病早期血浆MIF水平持续升高,检测就诊时MIF水平有助于预测远期不良预后。Objective To investigate dynamic changes of plasma macrophage migration inhibitory factor(MIF)in patients with acute ST-segment elevated myocardial infarction(STEMI). Methods We continuously recruited 204 STEMI patients with primary percutaneous coronary intervention(PCI).Age and sex-matched patients with stable angina(n=30)and healthy subjects(n=65)were selected as control groups.Plasma MIF levels of admission,24 h and 72 h after PCI were measured by enzyme linked immunosorbent assay(ELISA).STEMI patients were followed up for 36 months. Results Compared with control groups,plasma MIF levels of STEMI patients were significantly higher at admission and maintained at high levels until 24 h to 72 h[53.1(36.4,81.9)ng/ml,53.8(40.7,67.7)ng/ml,50.8(38.9,66.0)ng/ml,respectively,P<0.001]post-PCI and had no significant changes(ANOVA P>0.05).Plasma MIF levels of admission was correlated positively with peak levels of creatine kinase-MB and troponin T(r=0.439 and 0.316,both P<0.001),negatively with left ventricular ejection fraction(LVEF)(r=-0.338,P<0.001).Plasma MIF levels at admission and 24 h post PCI were associated with high sensitive-C reactive protein(r=0.173 and 0.148,both P<0.05).MIF at 24 h post PCI correlated with dynamic monocyte counts within 72 h after STEMI(r=0.305,0.195 and 0.237,all P<0.05).Also,MIF levels at 72 h post PCI were associated with monocyte counts at 24 h and 72 h post PCI(r=0.175 and 0.146,both P<0.05).Patients with higher MIF levels at admission(≥53.1 ng/ml)had 2.4-fold risk of major adverse cardiovascular and cerebral events(MACCE)during 36 months follow-up(95%CI:1.12-5.20,P=0.025). Conclusions In patients with STEMI,the lasting elevated levels of plasma MIF during early phase after STEMI appear to be associated with enzymatic infarct size,acute cardiac function,inflammatory factor and circulatory monocyte counts.Admission MIF level was correlated with prognosis and can help predict long-term adverse outcomes.

关 键 词：巨噬细胞游走抑制因子 冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 炎症细胞 

分 类 号：R542.22[医药卫生—心血管疾病]