急性冠状动脉综合征患者血清肿瘤坏死因子－α和白细胞介素－18的变化及临床意义

Objective To investigate the changes of serum tumor necrosis factor-α and interleukin18 and their clinical significance in patients with acute coronary syndrome. Methods 40 patients with acute myocardial infarction and 36 patients with unstable angina pectoris and 30 patients with stable angina pectoris (SAP group) and another 27 patients without coronary heart disease were included in this study. Patients in AMI group, UAP group and in SAP group were divided into three groups as a single-vessel disease group (n=26), a double-vessel disease group (n=47) and a triple-vessel disease group (n=33) according to the results of coronary angiography. The concentrations of serum TNF-α and IL-18 were determined by radioimmunoassay and were analyzed with the severity of ACS. Results ①The concentrations of serum TNF-α and IL-18 in AMI group were significantly higher than that of the UAP group, the SAP group and the control group (all P＜0.01) and in UAP group were significantly higher than that of the SAP group and the control group (all P＜0.01). There were no differences of serum TNF-α comparing between the SAP group and the control group (all P＞0.05) but the concentrations of serum IL-18 in SAP group were obviously higher than that of the control group (all P＜0.01). ② The concentrations of serum TNF-α and IL-18 in control group were significantly lower than that of the single-vessel disease group, the double-vessel disease group and the triple-vessel disease group (all P＜0.01) and in single-vessel disease group were significantly lower than that of the double-vessel disease group and the triple-vessel disease group (all P＜0.01). There were no differences of serum TNF-α comparing between the double-vessel disease group and the triple-vessel disease group (all P＞0.05) but the concentrations of serum IL-18 in double-vessel disease group were obviously lower than that of the triple-vessel disease group (all P＜0.01). Conclusion TNF-α and IL-18 which are related with the disruption of arterial atheromatous plaque are involved in the coronary artery lesion of ACS. The concentrations of serum TNF-α and IL-18 are important risk and predictive factors for patients with ACS, which are positively correlated with the severity of ACS.