急性冠状动脉综合征病人外周血超敏C反应蛋白、淀粉样A蛋白和白细胞介素-6的检测和临床意义

目的:观察急性冠脉综合征(ACS)发病时急性反应蛋白中的超敏C-反应蛋白(sCRP)、淀粉样A蛋白(SAA)和白细胞介素-6(IL-6)水平的变化,旨在探讨ACS发病机制。方法:选取ACS病人80例,其中急性心肌梗死(AMI)病人40例,不稳定性心绞痛(UAP)病人40例,同时选取正常对照40例。采用酶联免疫法(ELISA)测定上述病例和对照血清中的SAA、IL-6水平,采用免疫比浊法测定血清中sCRP水平,并进行统计学分析。结果:①sCRP、SAA、IL-6水平在AMI组、UAP组显著高于对照组。②选取CK-MB粗略代表心肌坏死的程度,分别在AMI组内和UAP组内对sCRP、SAA、IL-6、纤维蛋白原和CK-MB进行Spearman等级相关分析,发现sCRP、SAA、IL-6之间存在明显相关性,并且这种相关性在UAP组强于AMI组。纤维蛋白原在AMI组中与IL-6、SAA相关,在UAP组中与sCRP相关。③无论AMI组还是UAP组,CK-MB与sCRP、SAA、IL-6、纤维蛋白原之间均无相关性。④采用Wagner 37项/29分QRS积分系统对40例AMI病人进行梗死面积的估计,结果表明QRS积分≤6分组和>6分组之间sCRP、SAA、IL-6水平无明显差异。 结论:外周血中sCRP、SAA、IL-6水平可能作为诊断和预测ACS发生的敏感指标。血清中sCRP、SAA、IL-6的升高主要不是心肌坏死的作用,可能与多病灶的不稳定斑块的存在有关。

Serum acute phase reactants sCRP, SAA, IL- 6 in acute coronary syndrome and its clinical significance

AIM: To investigate the possible involvement of CRP, SAA, IL-6 and its significance in acute coronary syndrome. METHODS: Serum SAA, IL-6 and sCRP levels in 40 patients with AMI, 40 patients with UAP and 40 controls were measured by means of ELISA. RESULTS: Serum SAA, IL-6 and CRP were significantly higher in ACS group (AMI or UAP) than in control group. In the Spearman correlation analysis , we found a correlation among IL－6, SAA, sCRP, fibrinogen both in the AMI group and UAP group. There was no correlation between CK-MB and serum SAA, IL-6 and sCRP levels either in AMI group or in UAP group. In the AMI group, there was no difference of serum SAA,IL-6 and sCRP levels when divided into ≤6 score group and >6 score group using Wagner's QRS scoring system. CONCLUSIONS: Serum levels of certain inflammatory markers have some diagnostic value for ACS. The high levels of serum SAA, IL-6 and sCRP are not mainly caused by myocardial death, but by the inflammation in the multifocal unstable plague.