急性冠脉综合征患者血清hs-CRP和IL-6水平变化及预后意义

【目的】探讨炎性标志物C反应蛋白(CRP)、白介素-6(IL-6)与急性冠脉综合征(ACS)的发病及预后的关系。【方法】ACS患者112例,其中不稳定型心绞痛(UAP)51例,急性心肌梗死(AMI)61例(按治疗方法分3个亚组),稳定型心绞痛(SAP)10例,健康对照21例,测定其血清hs-CRP、IL-6水平,比较组间及亚组间差异,观察9例静脉溶栓再通患者早期系列血清标志物的水平变化,随访冠心病患者不良心血管事件与hs-CRP、IL-6的关系。【结果】与对照组、SAP组相比,UAP和AMI组hs-CRP、IL-6水平升高(P<0.05);AMI组中PCI亚组hs-CRP、IL-6水平治疗后较治疗前升高(P<0.05),静脉溶栓亚组IL-6水平治疗后较治疗前升高(P<0.05);9例溶栓再通患者IL-6在发病12h显著升高(P<0.01),达峰时间与CK-MB一致,而hs-CRP水平持续升高;ACS患者hs-CRP与IL-6呈正相关(rAMI=0.493,rUAP=0.452);hs-CRP、高脂血症是冠心病患者不良事件的预测因素(OR=1.163,OR=2.844),IL-6与冠心病患者预后无相关关系(P>0.05)。【结论】血清hs-CRP、IL-6水平是判断斑块稳定性的血清指标物;AMI患者血清IL-6来自心脏,而CRP并非由心脏释放;hs-CRP、高脂血症对冠心病预后判断具有重要价值。

Changes and prognostic value of serum high sensitivity-C reactive protein and interleukin-6 levels in patients with acute cononary syndrome

[Objective] To explore the role of serum C-reactive protein(CRP)and interleukin-6(IL-6)levels in the pathogenesis and prognosis of acute coronary syndrome(ACS).[Methods]Serum levels of hs-CRP,IL-6 were determined on admission in 51 patients with unstable angina pectoris(UAP),61 with acute myocardial infarction(AMI)(including 3 subgroups),10 with stable angina pectoris(SAP)and in 21 cases as control.Levels of hs-CRP,IL-6 in each group,as well as each subgoup were compared.Early serial serum biomarks were measured in 9 AMI patiants of successful thrombolysis.The relationship between hs-CRP,IL-6 and prognosis were analyzed by following up cardiovascular events.[Results]Compared with patients with SAP and control,levels of hs-CRP and IL-6 of those with ACS(including the UAP and AMI)augmented(P<0.05).Differences between before-and after-treatment of the levels of hs-CRP and IL-6 in PCI subgroup were significant(P<0.05).Differences between before-and after-treatment of the levels of IL-6 in venous thrombolysis were significant(P<0.05).Level of IL-6 reached its peak after onset familiar to CK-MB,while levels of hs-CRP were gradually increased.Serum hs-CRP levels were correlated positively to IL-6 in those with ACS(rAMI=0.493,rUAP=0.452).hs-CRP and hyperlipidemia were predictors for cardiovascular events in CHD patients(OR=1.163,OR=2.844).IL-6 was not correlated to the prognosis of CHD patients(P>0.05).[Conclusions]Serum levels of hs-CRP and IL-6 are biomarkers for evaluating vunerable plaque.Not Serum CRP,but IL-6 is released from heart in patients with AMI.hs-CRP and hyperlipidemia appear to be valuable for predicting vascular events.