| Objective To investigate the changes of Toll-like receptor 4 and serum tumor necrosis factor-? in peripheral blood mononuclear cells after percutaneous coronary intervention(PCI)in patients with acute myocardial infarction and the correlation with severity of coronary artery disease,and to explore its clinical significance.Methods Eighty patients were enrolled in the Department of Cardiology,the First Affiliated Hospital of Shihezi University Medical College from June 2014 to August 2015,combined with clinical manifestations and selective coronary angiography(CAG).All patients admitted to the hospital were given conventional coronary heart disease secondary prevention.Coronary heart disease diagnosis is in line with the World Health Organization diagnosis of coronary heart disease,confirmed by coronary angiography with at least one coronary artery diameter stenosis ? 50%.According to the above diagnostic criteria,the patients were divided into two groups: acute myocardial infarction(AMI)group of 30 cases(26 cases of male,female 4cases,age 52.17 ± 11.94 years old,the youngest age of 34 years,the maximum age was 82 years),30 cases of unstable angina pectoris(UAP)group(25 cases were male and 5 female,aged 55.6 ± 10.27 years,the youngest age was 34 years old,the maximum age was 73 years),20 cases of patients in the same period whose chest pain was not clear and showed no abnormalities after the routine examination and coronary angiography as a control group(Including male 14 cases,female 6 cases,the average age of 50.55 ± 9.49 years,the minimum age of 34,maximum age of 69 years).The levels of TLR4 in peripheral blood mononuclear cells(PBMCs)before and after PCI were observed by flow cytometry.The concentration of TNF-? in serum was detected by enzyme-linked immunosorbent assay(ELISA).Results(1)Before PCI treatment,the expression of TLR4 [AMI group: 67.6(77.15,60.15)%;UAP group:61.54(70.0,50.0)%] and serum TNF-? [AMI group: 12.01(14.36,8.0)pg/ml;UAP:6.65(8.64,3.54)pg/ml)was significantly higher than that in the control group [TLR4: 40.0(44.45,35.0)%,serum TNF-?:2.23(2.83,0.99)pg/ml],and the difference was statistically significant(P <0.01).The level of TNF-? in group AMI was higher than that in UAP group before PCI treatment,and the difference was statistically significant(P <0.05)(2)After PCI treatment,the levels of TLR4(AMI group: 50.75(60.33,46.18)%;UAP group:47.10(52.23,38.85)%)and serum TNF-? in AMI group and UAP group(AMI group: 5.30(6.81,3.08)pg / ml;UAP group:2.23(2.83,0.99)pg / ml)were significantly lower than those before treatment,and the difference was statistically significant(P <0.01).(3)The expression level of TLR4 in peripheral blood of AMI group and UAP group was positively correlated with serum TNF-? concentration(r = 0.635,P <0.01).(4)The expression of TLR4 and TNF-? in peripheral blood of patients with AMI before PCI was positively correlated with Gensini score of coronary artery disease(r= 0.709,P <0.01;r = 0.501,P <0.05).The expression of TLR4 and TNF-? in peripheral blood of ACS patients before treatment with PCI waspositively correlated with the Gensini score of coronary artery disease(r = 0.665,P <0.01;r = 0.453,P<0.01).Conclusions(1)The levels of TLR4 and tumor necrosis factor-? in peripheral blood of patients with AMI were higher than those in UAP group,and both groups were higher than those in control group,and the levels of TLR4 and TNF-? concentration in peripheral blood of patients with AMI were significantly positively correlated with the severity of coronary artery disease,suggesting that TLR4 and TNF-? may be involved in the development and progression of ACS,both of which can be used as indicators for the clinical prediction of AMI acute cardiovascular events.(2)The level of TLR4 and the concentration of TNF-? in patients with AMI and UAP after percutaneous PCI were significantly lower,indicating that the recovery of myocardial blood supply in patients with AMI may improve the inflammatory response of coronary artery and improve the long-term prognosis of patients. |
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