| BackgroundEmergency interventional therapy recanalizing the obstructed coronary artery is a definite primary means for the treatment of AMI now, the local inflammation induced by the reperfusion of ischemic myocardium causes myocardium injury to some extent, at the same time, stent implantation leads to vascular injury and draw-off, which causes acute injury of tunica intima and aggravates the inflammation of vessel. Now at home and abroad the results show that early revascularization of coronary artery of AMI patients could save dying myocardium, reduce the infarct size, improve systolic function and inhibit ventricular dilatation. Other results show that early reperfusion therapy(<3h) could reduce quantity of myocardial necrosis, limit infarct size and infarct depth, protect interstitial collagen, stabilize geometry of ventricle, inhibit reconstruction of left ventricle and improve function of left ventricle. However, clinical study of the dynastic concentration variation of inflammatory factor in infarct related artery recanalized via emergency intervention of AMI patients has not been reported.Objective To study the dynamic changes of tumor necrosis factor alpha (TNF-α), C-reaction protein and interleukin-17 (IL-17) in infarct related artery of patients with acute myocardial infarction (AMI) pre-and post interventional therapy, and investigate its clinical meaning.Methods 96 diagnosed AMI patients were chose on admission 3-5h (referring to ISFC/WHO diagnostic criteria of AMI patients in 1979), including 58 male patients and 38 female patients. Their average age was 58.8, range from 28 to 72. The patients with recent infection, systemic immunity disease, severe abnormal mechanism of coagulation, abnormal thyroid function, progressive liver disease and Nephropathy, septicemia, malignant tumor history, surgical trauma, used steroid hormone drug, cardiac functionⅣ, intractable cardiogenic shock difficult to be corrected were excluded. Among them,84 patients who were suitable for implanting stents were divided to reperfusion group and 12 patients who were received conservative therapy were divided to non-reperfusion group. Both groups are given before operation:aspirin 300mg,clopidogrel 600mg Po, normal saline 10ml+heparin 5000u intravenous injection,Ⅱb-Ⅲa receptor antagonist 10ml intravenous injection,5% glucose+10% potassium chloride 5.0ml+25% magnesium sulfate 10ml+isosorbide sorbic lipid 10mg intravenous injection. After right femoral artery puncture in operation, coronary angiography via angiography catheter, criminal vessel found, analysis on the advantages and disadvantages and coronary angioplasty under the guidance of guide wire, the examined blood of two groups are extracted from infarct related artery through the use of aspiration catheter at different periods separately. [The coronary stents are the EXCEL drug coating stent systems made in Ji-Wei medical material limited company(rapamycin)(Bare stents and other drug coating stent systems are excluded)]. Hemospasia from the reperfusion group are separately gained before recanalizing infarct related artery and at 0min,10min,30min,60min,120min,180min after recanalizing infarct related artery. The concentration of TNF-αin serum of patients are determinated With Radioimmunoassay, the concentration of CRP are determinated by immune turbidimetry, and the concentration of IL-17 are examined with the application of ELISA. Statistical analysis is applied with statistical software SPSS 10.0.Results1. The concentrations of TNF-αat different time of the reperfusion group and the non-reperfusion group:The expression of TNF-αreached the peak at 30 min after recanalizing infarct related artery via intervention of the reperfusion group; As time went on, the expression of TNF-αdecreased gradually; and that of non-reperfusion group increased gradually, however, there was no peak in non-reperfusion group. There were no difference between two groups at 0,10min after recanalizing the criminal artery, at 30min the concentration of TNF-a in the reperfusion group is higher than that of the non-reperfusion group (P<0.05), after then, the concentration of TNF-αdecreased gradually, and at 120min, the concentration of TNF-αof the reperfusion group is lower than that of the non-reperfusion group, at 180min, the concentration of TNF-αof the reperfusion group is low significantly (P<0.05)2. The concentrations of CRP at different time of the reperfusion group and the non-reperfusion group:The concentrations of CRP at different time of the reperfusion group showed a tendency of wave. The concentrations of CRP of the reperfusion group reached the peak at 30min after recanalizing the infarct artery, at 60min, the concentration of CRP of the reperfusion group is lower than that of the non-reperfusion group, at 120min and 180min, the concentration of CRP of the reperfusion group is low significantly (P<0.05)。That of non-reperfusion group increased gradually.3. The concentrations of IL-17 at different time of the reperfusion group and the non-reperfusion group:There were no different significantly about the concentrations of IL-17 between the reperfusion group and the non-reperfusion group at different time (P>0.05), however, both of them showed a tendency of increasing gradually.Conclusion1. The concentrations of TNF-α,CRP and IL-17 between two groups were higher than that of normal human before intervention, which suggested that all cytokines participated in lesions of heart.2. The concentrations of TNF-αCRP and IL-17 of the non-reperfusion group increased gradually at the time of observation, which suggested that lesion of heart was exacerbated continuously, and the concentrations of TNF-α,CRP of the reperfusion group decreased gradually after reaching the peak at 30min after stent implantation, which suggested that lesion was exacerbated to some extent by the reperfusion of obstructed vessel and stent implantation, but ischemic myocardium was salvaged due to blood supply, so that inflammation induced by ischemia and infarction was alleviated, and the advantage brought by that could offset the disadvantage induced by the reperfusion of obstructed vessel and stent implantation. Generally, the extent of inflammation reaction tends to decrease.3. The concentrations of IL-17 increased gradually, and peak phenomenon of that did not occur at the time of observation. Which suggested that on the hand, the higher expression of IL-17 than normal related significantly with lesion of cardiovascular, on the other hand, as a inflammatory factor of non-transient response, the expression of that could not be transcribed and synthesized immediately due to external factor in a short time.4. The detection of the concentrations of TNF-α,CRP and IL-17 of infarct related artery is more accurately and timely on the respect of reflecting local acute inflammation than the previous detection of that of peripheral venous blood. |
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