急性冠脉综合征患者血Th1/Th2漂移与冠脉病变特点及中医虚实证候的相关性

目的:探讨急性冠脉综合征（acute coronary syndrome，ACS）患者血Th1/Th2漂移与冠脉病变特点及胸痹虚实证候的相关性。方法:选取2010年5月~9月在山东省立医院及山东中医药大学第二附属医院心脏内科病房就诊行经皮冠状动脉造影(coronary arteriography,CAG)的患者66例，包括不稳定型心绞痛（unstable angina，UAP）患者22例、急性心肌梗死（acute myocardial infarction，AMI）患者11例、稳定型冠心病（SAP）患者33例，健康对照组20例。所有纳入对象均应用ELISA监测血干扰素γ（interferon-γ，IFN-γ）、白介素2 （interleukin-2，IL-2）、白介素4 （interleukin-4，IL-4）、白介素10（interleukin-10，IL-10）水平。冠状动脉造影采用Gensini积分、冠脉病变支数分析冠脉病变特点，并进行胸痹的辩证分型。结果: ①UAP组、AMI组患者IFN-γ、IL-2水平较SAP、正常对照组有显著升高（P<0.05），且存在AMI组>UAP组>SAP组，然而，各组间IL-4、IL-10水平均无明显差异。②ACS组Gensini积分与SAP组比较有显著差异。UAP组、AMI组、SAP组患者IFN-γ、IL-2水平与Gensini积分均呈显著正相关；IL-4、IL-10水平与Gensini积分均呈负相关。③1支病变组与2支病变组之间IFN-γ、IL-2水平均无显著差异，但均较3支病变组细胞因子水平低（P<0.05）。2支病变组与3支病变组之间IL-4、IL-10水平均无显著差异，但均较1支病变组细胞因子水平低（P<0.05）。④中医虚证组IL-2、IFN-γ水平及Genisi积分均较实证组明显增高（P<0.05）。结论:①血Th1/Th2向Th1方向的漂移与ACS发生有关，与冠脉病变的程度是相关的。②虚证患者冠脉病变程度较实证患者严重。③IFN-γ、IL-2水平增高，可作为中医胸痹虚证微观辨证指标。

Correlation between Th1/Th2 drift in blood and characteristics of coronary lesions,deficiency syndrome and sufficiency syndrome in patients with acute coronary syndrome

AIM: To study the correlation between Th1/Th2 drift in blood and characteristics of coronary lesions and to provide a clinical basis for introducing Th1/Th2 drift to the microdifferentiation of deficiency syndrome and sufficiency syndrome of xiongbi in traditional Chinese medicine(TCM).METHODS: All study patients underwent percutaneous coronary intervention(PCI) including 22 cases with unstable angina(UA),11 cases with acute myocardial infarction(AMI),six cases with syndrome X,and six cases with old myocardial infarction(OMI).During PCI,the characteristics of coronary lesions were evaluated by Gensini integral and the number of coronary arteries with plaque,and TCM syndrome differentiations were made.The healthy control group consisted of 20 cases.Serum levels of IFN-γ,IL-2,IL-4,and IL-10 were detected by ELISA.RESULTS: Levels of IFN-γ,IL-2 in UA group,AMI group and OMI group were all significantly higher than those in the control group(P<0.05),with IFN-γ in AMI group >UA group>OMI group.No significant difference was seen in levels of IL-2 among AMI,UA and OMI groups,but IL-2 in AMI group was higher than in the UA group.No significant difference in the levels of IL-4 and IL-10 was observed between groups.Levels of IFN-γ and IL-2 in ACS were positively related to the level of Gensini integral,but levels of IL-4 and IL-10 were negatively related to the level of Gensini integral.No significant difference was seen in the levels of IFN-γ and IL-2 between the group of one coronary artery with plaque and the group of two coronary arteries with plaque but were lower than those in the group of three coronary arteries with plaque(P<0.05).Levels of IL-4 and IL-10 were similar in the group of two coronary arteries with plaque and the group of three coronary arteries with plaque(P>0.05),but the level in the group of one coronary artery with plaque was higher than in the groups of two and three coronary arteries with plaque(P<0.05).Levels of IFN-γ,IL-2 and Gensini integral in sufficiency syndrome were significantly higher than those in deficiency syndrome(P<0.05).CONCLUSION: Increased levels of IFN-γ and IL-2 are not only predispositions of ACS,but are also aggravating factors of coronary artery plaques.Increased levels of IFN-γ and IL-2 can be used as indicators of sufficiency syndrome.