PCI對冠心病患者血清hs-CRP、IL-6、ox-LDL的影響

【摘要】  目的：觀察PCI對冠心病患者血IL-6、hs-CRP、ox-LDL的影響，探討IL-6、hs-CRP、ox-LDL與冠脈病變程度的相關性。方法：對94例冠心病患者行冠狀動脈造影(SCAG)，按SCAG結果分為PCI組67例和對照組27例，兩組均于術前及術后4小時取肘靜脈血，測定血清hs-CRP、IL-6及ox-LDL水平。結果：與術前比較，PCI組術后血清hs-CRP水平顯著增高(P<0.05)，IL-6、ox-LDL水平差異無統計學意義(P>0.05);與對照組比較，PCI組術前、術后血清hs-CRP、IL-6、ox-LDL水平差異均有統計學意義(P<0.05)。多支及雙支病變組術前和術后血清hs-CRP水平顯著高于單支病變組(P<0.05);多支病變組術前和術后IL-6水平顯著性高于雙支和單支病變組(P<0.05);三組間ox-LDL水平差異無統計學意義(P>0.05)。彌漫病變組和長病變組血清hs-CRP、IL-6水平明顯高于局限病變組，差異有統計學意義(P<0.05);血清ox-LDL水平各組間比較，差異無統計學意義(P>0.05)。結論：炎癥因子與ox-LDL對CHD的診斷、危險性預測具有臨床價值。CHD患者血清IL-6、hs-CRP水平與冠脈病變程度存在相關性。

【關鍵詞】  冠心病PCIIL-6hs-CRPox-LDL

　AbstractObjective:To observe the effect of percutaneous coronary internvention(PCI) on the serum levels of hs-CRP,IL-6 and ox-LDL in patients with coronary heart disease(CHD) and to analyze the relationship between their levels and the severity of CHD.　　Methods:Selective coronary angiography was performed in 94 CHD patients.Angiographic images showed that CHD patients with one-vessel,two-vessel,and multi-vessel stenosis and showed long,diffuse,and local lesions.The patients were divided into PCI group (67 patients) and control group (27 patients) by different angiographic results.Blood samples were harvested in 4 hours after treatment and serum hs-CRP,IL-6 and ox-LDL levels were measured.Results:Compared to those before treatment,hs-CRP was significantly increased in the PCI group(P<0.05),while IL-6 and ox-LDL did not differ(P>0.05);compared to those in the control group,hs-CRP,IL-6,and ox-LDL were markedly different both before and after treatment(P<0.05).Both before and after treatment,CHD patients with two- and multi-vessel stenosis had higher hs-CRP level than those with one-vessel did(P<0.05);those with multi-vessel stenosis had higher IL-6 level than those with one- or two-vessel stenosis(P<0.05);no difference was noted in ox-LDL level among the 3 groups.CHD patients with diffuse and long lesions had increased hs-CRP and IL-6 as compared to those with local lesions(P<0.05);ox-LDL did not differ among the 3 groups(P>0.05).Conclusion:PCI may be effective to improve the levels of hs-CRP,IL-6 and ox-LDL and these factors are related to the severity of CHD.

　　Key wordscoronary heart diseasepercutaneous coronary interventionIL-6hs-CRPox-LDL

　　一般認為，冠狀動脈性心臟病(coronary artery heart disease,CHD)的發生與發展與炎癥反應密切相關，高敏C反應蛋白(hs-CRP)為CHD獨立危險因子;IL-6促進血管內皮細胞和血管平滑肌細胞(VSMC)的增生，參與冠狀動脈硬化的形成和發展。研究[1]證實，氧化低密度脂蛋白(ox-LDL)可誘導動脈粥樣硬化斑塊內泡沫細胞形成，是動脈粥樣硬化發生、發展的獨立危險因子。本研究對94例冠心病患者進行冠狀動脈造影(SCAG)，其中67例經皮冠狀動脈介入治療(PCI)，觀察PCI對冠心病患者血IL-6、hs-CRP、ox-LDL的影響，探討IL-6、hs-CRP、ox-LDL與冠脈病變程度的相關性。

　　1臨床資料

　　2009年7月—11月參照《內科學》第6版“CHD診斷標準”[2]擬診為CHD住院患者94例，入院后行SCAG，其中67例SCAG陽性患者接受同步PCI(PCI組)，男 46 例，女21例，年齡46～85歲，平均(61.4±10.9)歲，病程1個月～10年，平均5.5年;67例中合并高血壓病41例，糖尿病8例。 SCAG陰性27例(對照組)，男13 例，女14例，年齡44～75歲，平均(61.3±10.8)歲，病程2個月～4.5年，平均3.6年;27例中合并有高血壓病20例，合并陳舊性腦梗死4例，糖尿病3例。PCI組患者在冠狀動脈主要病變血管實施PTCA及支架置入。PCI組患者均為急性心肌梗死發病后1周或心絞痛發作穩定5天以上，且無急性感染證據。兩組患者性別、年齡、病程等資料均衡，具有可比性。

　　2方法論文發表核心期刊

　　2.1PCI采用Judkins法作選擇性冠脈造影，由兩位以上有經驗的專科醫師進行SCAG結果分析和判定。

　　2.2觀察指標及方法兩組患者手術前日、術后4小時取肘靜脈抽血，離心取血清-70℃冰箱儲存，酶聯免疫吸附反應法(ELISA法)測定IL-6、hs-CRP、ox-LDL濃度。

　　2.3統計學方法計量資料以(±s)表示，采用t檢驗，單因素方差分析。
3結果

　　3.1SCAG前后兩組IL-6、hs-CRP、ox-LDL水平比較PCI組術后與術前比較，血清hs-C