急性心肌梗死患者血清炎性因子水平及二级预防状况的随访观察

目的 观察急性ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者血清炎性因子水平3年的动态变化及二级预防的情况。方法 选择初次发病且发病6 h内就诊的急性STEMI患者84例,其中男性70例,女性14例,平均年龄59岁。随访3年,记录患者临床资料,采用酶联免疫吸附法(enzyme-linked immunosorbent assay, ELISA)测定血清白细胞介素6(interleukin-6,IL-6)、可溶性白细胞分化抗原40配体(CD40 ligand,sCD40L)、基质金属蛋白酶-9(metalloproteinase-9,MMP-9)以及基质金属蛋白酶组织抑制因子-1(tissue inhibitor of metalloproteinase-1,TIMP-1)的水平。结果 在心肌梗死3年随访期与急性期比较,IL-6、sCD40L水平显著降低(P均<0.001),MMP-9 水平轻度降低,TIMP-1水平升高(P=0.001),MMP-9/TIMP-1比值降低(P<0.001)。3年随访时,STEMI患者应用血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂及他汀类药物的比例较住院期间显著降低,分别为54.8%、73.8%及57.1%,血压、低密度脂蛋白胆固醇及体质量指数达标率较低,分别为39.9%、27.4%及45.2%。结论 IL-6、sCD40L、MMP-9水平升高以及MMP-9/TIMP-1平衡失调与STEMI急性期斑块不稳定乃至破裂有关;心肌梗死患者出院后二级预防水平下降,应强化随访,积极规范进行降压、调脂等治疗。

A cohort study on the levels of serum inflammatory factors and secondary prevention in patients with acute ST segment elevation myocardial infarction

Objective To investigate the changes of the levels of serum inflammatory factors and secondary prevention in patients with acute ST segment elevation myocardial infarction (STEMI) during the 3-years follow-up. Methods A vertical sectional survey was performed on 84 patients with first STEMI who were admitted to our institute within 6 h of symptoms onset. Clinical data were collected, and serum levels of interleukin-6 (IL-6), soluble CD40 ligand (sCD40L), metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by sandwich enzyme-linked immunosorbent assay (ELISA) at baseline and 3 years of follow-up.Results STEMI patients at 3-years follow up had lower levels of serum IL-6, sCD40L and MMP-9, and a higher level of TIMP-1 compared with admission phrase. During the 3-years follow-up period, the proportion of STEMI patients who took angiotensin-converting enzyme inhibitors, or angiotensin Ⅱ receptor blocker and statins were 54.8%, 73.8% and 57.1% respectively, which were decreased significantly compared with those measured during hospitalization, and the rate of achieving goal of blood pressure, 1ow-density lipoprotein cholesterol and body mass index were 39.9%, 27.4% and 45.2%, respectively. Conclusion The present study indicates that elevated circulating level of interleukin-6, sCD40L, MMP-9 and imbalance between MMP-9 and TIMP-1 may be responsible at least in part for atherosclerotic plaque development and rupture. We should carry out intensive follow-up management including antihypertensive and lipid lowing intervention to improve the secondary prevention of STEMI patients after discharge.