血清多种生化指标在PCI患者围术期的浓度变化
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摘要
目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者心型脂肪酸结合蛋白(heart-type fatty acid-binding protein,h-FABP)、缺血修饰清蛋白(ischemia modified albumin,IMA)、白细胞介素-2受体(interleukin-2receptor,IL-2R)、白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、髓过氧化物酶(myeloperoxidase,MPO)等指标在术后24h内的变化规律。方法收集2011年11月~2012年2月北京协和医院心内监护室实施PCI术后34例患者2,4,8和24h血清标本,分别检测IL-2R,IL-6,IL-8,TNF-α,h-FABP,IMA和MPO血清浓度。结果 MPO,h-FABP和CKMB浓度在PCI术后2h已明显升高(2h与24h比较,Z值分别为-3.621,-5.123,-2.789,均P<0.05),h-FABP浓度在24h内快速降到正常范围内,MPO浓度在4h后明显降低,CKMB浓度在4h达峰值,然后迅速降低;CK,cTnI浓度在PCI术后4h升高(4h和24h比较,Z值分别为-2.803,-2.31,均P<0.05),8h达峰值后逐渐降低。Spearman相关分析cTnI与CKMB,CK相关系数大于0.6以上。结论研究发现PCI术后多种生化标志物的变化规律,为临床诊治提供依据。
Objective To evaluate the perioperative changes of h-FABP,IMA,IL-2 R,IL-6,IL-8,TNF-αand MPO in patients with PCI.Methods The serial serum samples from 34 patients were collected from November of 2011 to February of 2012 in coronary care unit of Peking Union Hospital on separately 2,4,8 and 24 hours after PCI,then IL2 R,IL6,IL8,TNF-α,hFABP,IMA and MPO were measured.Results MPO,h-FABP and CKMB increased dramatically at 2 hours after PCI(Z value were separately-3.621,-5.123 and-2.789 compared with the level at 2 hand 24 h,all P<0.05),and h-FABP within 24 hours fell into the normal range.MPO dropped quickly after 4 hours of surgery and CKMB peaked at 4 hours,then decreased.The concentration of CK and cTnI rose up at 4 h(Z value were separately-2.803 and-2.31 compared with the level at 2 hand 24 h,all P<0.05)and declined with a climax at 8 hafter PCI.The correlation coefficient of CKMB and CK with cTnI were higher than 0.6.Conclusion This study provided an overview of the change of multi-biomarkers following PCI,which gave a valuable information for clinical treatment.
Objective To evaluate the perioperative changes of h-FABP,IMA,IL-2 R,IL-6,IL-8,TNF-αand MPO in patients with PCI.Methods The serial serum samples from 34 patients were collected from November of 2011 to February of 2012 in coronary care unit of Peking Union Hospital on separately 2,4,8 and 24 hours after PCI,then IL2 R,IL6,IL8,TNF-α,hFABP,IMA and MPO were measured.Results MPO,h-FABP and CKMB increased dramatically at 2 hours after PCI(Z value were separately-3.621,-5.123 and-2.789 compared with the level at 2 hand 24 h,all P<0.05),and h-FABP within 24 hours fell into the normal range.MPO dropped quickly after 4 hours of surgery and CKMB peaked at 4 hours,then decreased.The concentration of CK and cTnI rose up at 4 h(Z value were separately-2.803 and-2.31 compared with the level at 2 hand 24 h,all P<0.05)and declined with a climax at 8 hafter PCI.The correlation coefficient of CKMB and CK with cTnI were higher than 0.6.Conclusion This study provided an overview of the change of multi-biomarkers following PCI,which gave a valuable information for clinical treatment.
引文
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[15]Singh TP,Nigam AK,Gupta AK,et al.Cardiac biomarkers:when to test?-physician perspective[J].Journal Indian Academy of Clinical Medicine,2011,12(2):117-121.
[2]Levine GN,Bates ER,Blankenship JC,et al.2011ACCF/AHA/SCAI guideline for percutaneous coronary intervention:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions[J].Circulation,2011,124(23):e574-651.
[3]Ahmad T,Fluzat M,Felker GM,et al.Novel biomarkers in chronic heart failure[J].Nat Rev Cardiol,2012,9(6):347-359.
[4]王继贵.急性冠脉综合征生化标志物研究的现代进展[J].现代检验医学杂志,2012,27(3):1-5,9.Wang JG.Modern progress of research on biochemical markers in acute coronary syndrome[J].Journal of Modern Laboratory Medicine,2012,27(3):1-5,9.
[5]Al-Hadi HA,Fox KA.Cardiac markers in the early diagnosis and management of patients with acute coronary syndrome[J].Sultan Qaboos University Medical Journal,2009,9(3):231-246.
[6]Brennan ML,Penn MS,Van Lente F,et al.Prognostic value of myeloperoxidase in patients with chest pain[J].N Engl J Med,2003,349(17):1595-1604.
[7]Pang Z,Zhao W,Yao Z.Cardioprotective effects of nicorandil on coronary heart disease patients undergoing elective percutaneous coronary intervention[J].Med Sci Monit,2017,23:2924-2930.
[8]胡道军,郁淼,张洪磊,等.基于logistics回归和ROC曲线综合评价IMA,NLR,hsCRP和CKMB联合检测对早期急性心肌梗死的诊断价值[J].现代检验医学杂志,2016,31(5):76-80.Hu DJ,Yu M,Zhang HL,et al.Comprehensive evaluation of the diagnostic value of the combined detection of IMA,NLR,hs-CRP and CK-MB for acute myocardial infarction based on ROC curve and logistic regression analysis[J].Journal of Modern Laboratory Medicine,2016,31(5):76-80.
[9]肖路延,王萌,唐志毅,等.缺血修饰清蛋白在急性冠状动脉综合征早期诊断中的临床意义[J].现代检验医学杂志,2009,24(3):154-157.Xiao LY,Wang M,Tang ZY,et al.Clinical significance of ischemia modified albumin in early diagnosis of acute coronary syndromes[J].Journal of Modern Laboratory Medicine,2009,24(3):154-157.
[10]AndriéRP,Becher UM,Frommold R,et al.Interleukin-6is the strongest predictor of 30-day mortality in patients with cardiogenic shock due to myocardial infarction[J].Critical Care,2012,16:R152.
[11]Frangogiannis NG.The inflammatory response in myocardial injury,repair and remodeling[J].Nature Reviews Cardiology,2014,11(5):255-265.
[12]梁瀛,王新宇,牛杰,等.急性心肌梗死患者血清炎症因子的动态变化及相互关系[J].中华医学杂志,2011,91(12):819-823.Liang Y,Wang XY,Niu J,et al.Temporal changes and interaction of serum cytokines in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention[J].National Medical Journal of China,2011,91(12):819-823.
[13]Nursalim A,Suryaatmadja M,Panggabean M.Potential clinical application of novel cardiac biomarkers for acute myocardial infarction[J].Acta Med Indones,2013,45(3):240-250.
[14]喻红波,刘阳,罗俊卿,等.髓过氧化物酶在非ST段抬高急性冠状动脉综合征诊断和预后中的临床应用[J].现代检验医学杂志,2015,30(3):77-79.Yu HB,Liu Y,Luo JQ,et al.Clinical application of myeloperoxidase in diagnosis and prognosis of NonST elevation acute cornary syndromes[J].Journal of Modern Laboratory Medicine,2015,30(3):77-79.
[15]Singh TP,Nigam AK,Gupta AK,et al.Cardiac biomarkers:when to test?-physician perspective[J].Journal Indian Academy of Clinical Medicine,2011,12(2):117-121.