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1、河南科技大学 硕士学位论文 急性心肌梗死患者血浆TNF-与hsCRP的变化及意义 姓名：韩明磊 申请学位级别：硕士 专业：内科学 指导教师：王绍欣 20100501 摘 要 I 论文题目：急性心肌梗死患者血浆 TNF-与 hsCRP 的变化及意义 论文题目：急性心肌梗死患者血浆 TNF-与 hsCRP 的变化及意义 专 业：内科学 专 业：内科学 研 究 生：韩明磊 研 究 生：韩明磊 指导教师：王绍欣 副教授 指导教师：王绍欣 副教授 摘 要 摘 要 目的：目的： 通过测定急性心肌梗死患者血浆肿瘤坏死因子（TNF-）与高敏 C 反应蛋白（hsCRP）的浓度，探讨急性心肌梗死患者在经皮冠状动脉
2、介入治疗 （PCI）术前及术后血浆肿瘤坏死因子（TNF-）与高敏 C 反应蛋白 （hsCRP）的变化及意义。 方法：方法： 采用固相夹心酶联免疫法测定 50 例急性心肌梗死（AMI）患者发病后 612 小时以内（PCI 术前）、术后 24 小时、48 小时、72 小时、5 天、7 天、 14 天时，血浆 TNF- 与 hsCRP 的浓度；同时测定 25 例因不典型胸部不适在我 科住院并经冠状动脉造影证实冠状动脉正常患者的术前血浆 TNF- 与 hsCRP 的 浓度，将其做对照组；根据术后患者的病情变化将急性心肌梗死组分为 3 个亚 组：死亡组、并发症组及无并发症组。 结果：结果： 1. 术前心
3、肌梗死组与对照组血浆 TNF- 与 hsCRP 浓度变化 术前心肌 梗死组血浆 TNF- 与 hsCRP 浓度明显高于对照组，分别为 TNF- (119.40 67.58)ng/L vs (19.647.55)ng/L，hsCRP(1.430.93)mg/L vs (0.520.16)mg/L(均 P0.01）。 2. 血浆 TNF- 与 hsCRP 浓度与 Gensini 评分呈正相关，冠状动脉 Gensini 评分越高，血浆 TNF- 与 hsCRP 浓度升高越明显。 3. 血浆 TNF- 不同时间点的变化 3 亚组 TNF- 在术后 1 天均比术前显著升 高，并发症组和无并发症组在术后
4、2 天开始下降，而死亡组则在术后 15 天呈 直线上升，到第 7 天才开始下降，至术后 14 天无并发症组和并发症组已下降到 低于术前的水平，而死亡组则高于术前的水平，3 组的组间、不同时点以及组间 和不同时点的交互作用差异均有统计学意义； 4. 血浆 hsCRP 不同时点浓度变化 3 亚组 hsCRP 在术后 1 天也开始升高， 无并发症组和死亡组升高的峰值在术后第 3 天，随后逐渐下降，但下降的幅度随 病情严重程度逐渐减小，3 组的组间、不同时点以及组间和不同时点的交互作用 差异均有统计学意义。 5. 并发症组与无并发症组 TNF- 与 Hs-CRP 的浓度对比 有并发症患者 河南科技大学
5、硕士学位论文 II TNF- 的浓度于术后 24h 达到峰值，其后缓慢下降，于 14d 仍显著高于无并发症 患者，差异有统计学意义（P0.05），无并发症患者也于术后 24h 达到峰值， 其后迅速下降，于术后 5d 基本降至正常；有并发症患者 Hs-CRP 的浓度于 3d 达 到高峰，其后缓慢下降，于术后 14d 仍显著高于无并发症患者，差异有统计学意 义（P0.05），无并发症患者 TNF- 的浓度于术后 48h 达到高峰，其后迅速下 降，于术后 7d 已基本降至正常。 结论：结论： 1. AMI 患者血浆 TNF- 与 hsCRP 浓度明显升高，其峰值延迟甚至持 续不降提示病情严重，对 A
6、MI 患者的近期及长期预后有一定的预测价值。 2. AMI 患者血浆 TNF- 与 hsCRP 的浓度的动态变化，可作为临床病情评估 及心血管事件发生发展的预测指标，对于指导临床进行早期积极干预及预防并 发症的发生有重要意义。 关 键 词：关 键 词：心肌梗死，经皮冠状动脉介入治疗，肿瘤坏死因子，高敏 C 反应 蛋白 论文类型：论文类型：应用基础研究 英文摘要 III Subject: Changing and significance of plasmic TNF- and hsCRP in patients with acute myocardial infarction Specialt
7、y: Internal Medicine Name: Han Minglei Supervisor: Associate professor Wang shao xin ABSTRACT Objective： To investigate the changing and significance of plasma tumor necrosis factor-alpha (TNF-) and high sensitivity C-reactive protein (hsCRP) in acute myocardial infarction (AMI) patients with emerge
8、ncy Percutaneous Coronary Intervention (PCI). Methords： Plasmic level of TNF- and hsCRP in 50 AMI patients were assaied within onset 612h of AMI(before PCI) and at 24h, 48h, 72h, 5d, 7d and 14d by Enzyme-linked immunosorbent assay (ELISA). The AMI group was divided into 3 sub-groups: the death group
9、, the complication group and the no complication group. Meanwhile, the plasmic level of the two inflammatory factors in 25 controls also were detected before coronary artery angiography . Results： l. Plasmic level of TNF- and hsCRP at pre-operative were higher in patients with AMI than the controls,
10、 respectively TNF- (119.467.58)ng/L vs (19.647.55)ng/L and hsCRP (1.430.93)mg/L vs (0.520.16)mg/L (each P0.01); 2. The plasmic concentration of TNF- and hsCRP was positively correlated with Gensini score, the higher Gensini score, the more obvious the concentration of TNF- and hsCRP was increased. 3
11、. In the three sub-groups, plasmic concentrations of TNF-at post-operative first day were markedly higher than at pre-operative. The complication group and the no complication group had already decreased on 2 day, but the death group which was not increased until on 5 day began to decrease on 7 day.
12、 On 14 day the complication group and no complication group had alreadyly lowed to pre-operative level, but the death group was still higher than pre-operation level. Among three groups, the differenet time points and the interaction of among groups and the different time points, the each difference
13、s were statistically significance. 4. In the three sub-groups, plasmic levels of hsCRP had already also began to increase after one day, the peak value concentrations of the no complication group and 河南科技大学硕士学位论文 IV the death group had been reached by 3 day, then decreased gradually, but the more se
14、rious in condtions, the slower in decline. Among three groups, the different time points, the interaction of among groups and the different time points, the differences were statistically significance. 5. The concentrations comparision of TNF- and hsCRP in patients with the complication group and no
15、 complication group. In complication group, the concentration of TNF- reached to the peak value after 24h post-operation, followed by slow decline, were still significantly higher than the no complication group on 14d, the difference was statistically significance (P2mm；血清心肌酶学升高超过正常上限两倍 以上）。其中男 28 例，女 22 例，年龄 2878 岁，平均（61.012.6）岁；下 壁、后壁、右心室心肌梗死 24 例，广泛前壁心肌梗死 8 例，前壁心肌梗死 13 例，侧壁、高侧壁心肌梗死 3 例；其中心力衰竭、心源性休克 12 例，主动脉内 球囊反搏术（IABP）应用 8 例，支架内亚急性血栓形成 2 例，死亡 4 例，局部 血肿 5 例，根据以上情况将急性心肌梗死组分为 3 个亚组：无并发症组、并发症 组和死亡组，其中并发症为再灌注损伤、恶性心律失常、心力衰竭、心源性休 克
