PCI对冠心病患者血清hs-CRP、IL-6、ox-LDL的影响

【摘要】  目的：观察PCI对冠心病患者血IL-6、hs-CRP、ox-LDL的影响，探讨IL-6、hs-CRP、ox-LDL与冠脉病变程度的相关性。方法：对94例冠心病患者行冠状动脉造影(SCAG)，按SCAG结果分为PCI组67例和对照组27例，两组均于术前及术后4小时取肘静脉血，测定血清hs-CRP、IL-6及ox-LDL水平。结果：与术前比较，PCI组术后血清hs-CRP水平显著增高(P<0.05)，IL-6、ox-LDL水平差异无统计学意义(P>0.05);与对照组比较，PCI组术前、术后血清hs-CRP、IL-6、ox-LDL水平差异均有统计学意义(P<0.05)。多支及双支病变组术前和术后血清hs-CRP水平显著高于单支病变组(P<0.05);多支病变组术前和术后IL-6水平显著性高于双支和单支病变组(P<0.05);三组间ox-LDL水平差异无统计学意义(P>0.05)。弥漫病变组和长病变组血清hs-CRP、IL-6水平明显高于局限病变组，差异有统计学意义(P<0.05);血清ox-LDL水平各组间比较，差异无统计学意义(P>0.05)。结论：炎症因子与ox-LDL对CHD的诊断、危险性预测具有临床价值。CHD患者血清IL-6、hs-CRP水平与冠脉病变程度存在相关性。

【关键词】  冠心病PCIIL-6hs-CRPox-LDL

　AbstractObjective:To observe the effect of percutaneous coronary internvention(PCI) on the serum levels of hs-CRP,IL-6 and ox-LDL in patients with coronary heart disease(CHD) and to analyze the relationship between their levels and the severity of CHD.　　Methods:Selective coronary angiography was performed in 94 CHD patients.Angiographic images showed that CHD patients with one-vessel,two-vessel,and multi-vessel stenosis and showed long,diffuse,and local lesions.The patients were divided into PCI group (67 patients) and control group (27 patients) by different angiographic results.Blood samples were harvested in 4 hours after treatment and serum hs-CRP,IL-6 and ox-LDL levels were measured.Results:Compared to those before treatment,hs-CRP was significantly increased in the PCI group(P<0.05),while IL-6 and ox-LDL did not differ(P>0.05);compared to those in the control group,hs-CRP,IL-6,and ox-LDL were markedly different both before and after treatment(P<0.05).Both before and after treatment,CHD patients with two- and multi-vessel stenosis had higher hs-CRP level than those with one-vessel did(P<0.05);those with multi-vessel stenosis had higher IL-6 level than those with one- or two-vessel stenosis(P<0.05);no difference was noted in ox-LDL level among the 3 groups.CHD patients with diffuse and long lesions had increased hs-CRP and IL-6 as compared to those with local lesions(P<0.05);ox-LDL did not differ among the 3 groups(P>0.05).Conclusion:PCI may be effective to improve the levels of hs-CRP,IL-6 and ox-LDL and these factors are related to the severity of CHD.

　　Key wordscoronary heart diseasepercutaneous coronary interventionIL-6hs-CRPox-LDL

　　一般认为，冠状动脉性心脏病(coronary artery heart disease,CHD)的发生与发展与炎症反应密切相关，高敏C反应蛋白(hs-CRP)为CHD独立危险因子;IL-6促进血管内皮细胞和血管平滑肌细胞(VSMC)的增生，参与冠状动脉硬化的形成和发展。研究[1]证实，氧化低密度脂蛋白(ox-LDL)可诱导动脉粥样硬化斑块内泡沫细胞形成，是动脉粥样硬化发生、发展的独立危险因子。本研究对94例冠心病患者进行冠状动脉造影(SCAG)，其中67例经皮冠状动脉介入治疗(PCI)，观察PCI对冠心病患者血IL-6、hs-CRP、ox-LDL的影响，探讨IL-6、hs-CRP、ox-LDL与冠脉病变程度的相关性。

　　1临床资料

　　2009年7月—11月参照《内科学》第6版“CHD诊断标准”[2]拟诊为CHD住院患者94例，入院后行SCAG，其中67例SCAG阳性患者接受同步PCI(PCI组)，男 46 例，女21例，年龄46～85岁，平均(61.4±10.9)岁，病程1个月～10年，平均5.5年;67例中合并高血压病41例，糖尿病8例。 SCAG阴性27例(对照组)，男13 例，女14例，年龄44～75岁，平均(61.3±10.8)岁，病程2个月～4.5年，平均3.6年;27例中合并有高血压病20例，合并陈旧性脑梗死4例，糖尿病3例。PCI组患者在冠状动脉主要病变血管实施PTCA及支架置入。PCI组患者均为急性心肌梗死发病后1周或心绞痛发作稳定5天以上，且无急性感染证据。两组患者性别、年龄、病程等资料均衡，具有可比性。

　　2方法论文发表核心期刊

　　2.1PCI采用Judkins法作选择性冠脉造影，由两位以上有经验的专科医师进行SCAG结果分析和判定。

　　2.2观察指标及方法两组患者手术前日、术后4小时取肘静脉抽血，离心取血清-70℃冰箱储存，酶联免疫吸附反应法(ELISA法)测定IL-6、hs-CRP、ox-LDL浓度。

　　2.3统计学方法计量资料以(±s)表示，采用t检验，单因素方差分析。
3结果

　　3.1SCAG前后两组IL-6、hs-CRP、ox-LDL水平比较PCI组术后与术前比较，血清hs-C