急性心肌梗死患者血浆白细胞介素-8水平及其与室壁瘤形成关系的研究

目的 通过测定急性心肌梗死(AMI)患者早期血浆IL-8浓度水平变化结合同时导管法左心室造影(LVG)心室容积、压力及形态的变化,探讨IL-8在AMI后急性室壁瘤(LVA)形成患者血浆中的动态变化特点及其与LVA形成和心功能状态的关系.方法 将首次前壁AMI患者62例根据入院即刻LVG结果分为LVA形成组(29例)和无LVA组(33例).均于发病后6、12、18、24、48、72 h采血检测IL-8.于PCI完成后即刻及6个月复查时行LVG,测定左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室射血分数(LVEF)、室壁运动记分(WMS)、左心室舒张末期压(LVEDP).随访6个月内主要恶性心脏事件(MACE)的发生率.结果 ①wA形成组自AMI发作至再灌注时间较无LVA组明显延长(t=2.35,P＜0.05),同时Killip Ⅲ级心力衰竭发生率明显高于无LVA组(χ2=12.63,P＜0.05).②LVA形成组血浆IL-8峰值浓度明显高于无LVA组(0.64±0.08)μg/L与(0.53 ±0.09)μg/L,t=2.17,P＜0.05],同时峰值时间显著早于无LVA组(8.12±2.01)h与(10.5±2.65)h,t=2.42,P＜0.05].③PCI后即刻和术后6个月时,无LVA组LVEF、LVESVI、LVEDVI、WMS和LVEDP各参数均优于有LVA形成组t值分别为2.57,2.02,2.32,2.43,1.99;2.55,2.41,2.22,2.17,2.62,P均＜0.05).④LVA形成组患者在6个月随访期间梗死后心绞痛、NYHAI≥3级心力衰竭发生率及随访期间病死率明显高于无LVA组患者(18.51%与3.03%,χ2=14.92;40.74%与18.18%,χ2:23.27;17.24%与3.03%,χ2=16.01;P均＜0.05).结论 血浆IL-8水平在AMI后LVA形成患者中明显高于无LVA者,且与左心室重构程度和血流动力学变化密切相关,提示心肌血管免疫炎症递质IL-8的过度激活参与了AMI后LVA的形成过程,并影响着AMI后左心室重构和LVA的进程.

The relationship of plasma interleukin-8 and the left ventricular aneurysm formation in patients with acute myocardial infarction

Objective To investigate the relationship of interleukin-8(IL-8)and the left ventricular aneurysm(LVA)and cardiac function in acute myocardial infarction(AMI)patients using left ventriculography(LVG).Methods 62 patients with primary anterior AMI accompanied LVA diagnosed by LVG on admission were divided into LVA group(n＜29)and non-LVA group(n＜33).Plasma IL-8 levels were measured at 6,12,18 houm,1 st,2nd and 3rd day after the onset of AMI.At the time immediately after PCI and 6th month following AMI,the parameters of left ventricular end diastolic volume index(LVEDVI),left ventricular end systolic volume index(LVESVI),left ventricular ejection fraction(LVEF),wall motion score(WMS)and left ventricular end diastolic pressure(LVEDP)were measured by LVG.The main adverse cardiac events(MACE)were recorded within 6 months of follow up.Results ①The interval time of onset to reperfusion in LVA group was longer(t=2.35,P＜0.05)and the incidence of Killip Ⅲ grade was higher than those in non-LVA group(χ2=12.63,P＜0.05).②The peak value of plasma IL-8 in LVA group was significantly higher(0.64±0.08μg/L vs 0.53±0.09μg/L,t=2.17,P＜0.05)and the peak time ofplasma IL-8 was much earlier than those in the non-LVA group(8.12±2.01 hvs 10.5±2.65 h,t=2.42,P＜0.05).③At 6th month following AMI,the value of LVEF,LVESVI,LVEDVI,WMS and LVEDP in non-LVA group were much better than those in LVA group(t values are 2.57,2.02,2.32,2.43,1.99;2.55,2.41,2.22,2.17,2.62 respectively;P＜0.05 for each).④Within 6 months of follow-up,the incidences of angina after AMI.heart failure of NYHAI≥3 grade and mortality in LVA group were significantly higher than those in the non-LVA group(18.51%vs 3.03%,χ2=14.92;40.74%vs 18.18%,χ2=23.27;17.24%vs 3.03%,χ2=16.01;P＜0.05 for each).Conclusion Plasma IL-8 is significantly increased and closely correlated with left ventricular remodeling status and hemodynamic change in patients with LVA after AMI,indicating the overactivity of immune inflammatory medium(IL-8)involves in the process of LVA formation and an influence on the remodeling of left ventrieular following AMI.