纤维蛋白原与心肌缺血再灌注损伤患者炎症反应的相关性分析
Correlation between fibrinogen and inflammation in patients with myocardial ischemia/reperfusion injury

摘要：目的 分析纤维蛋白原(FIB)与心肌缺血再灌注损伤(MIRI)早期炎症反应的相关性，探讨FIB对MIRI炎症反应的预测价值。方法 纳入98例急性心肌梗死患者，对照组(即CAG组)仅行冠状动脉造影术(CAG)，MIRI组(即PCI组)先后连续进行CAG和经皮冠脉成形术(PCI)。各组患者分别于术前(造影前)及术后2h采集患者静脉血，采用酶联免疫吸附法检测血浆FIB、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)以及肿瘤坏死因子α(TNF-α)、髓过氧化物酶(MPO)、巨噬细胞游走抑制因子(MIF)含量。根据血浆FIB水平将MIRI组分为3个血栓亚组，分析血浆FIB水平与炎症因子表达的相关性。结果 MIRI组患者血浆FIB、CK-MB、cTnI含量显著高于对照组(CAG组)(P<0.05或P<0.01)，血浆炎症因子TNF-α、MPO、MIF含量明显升高 (P<0.05)。FIB水平与炎症因子TNF-α、MPO、MIF水平存在一定相关性(r值分别是0.625，0.756，0.864，P<0.01)。结论 血浆FIB水平与MIRI的炎症反应具有一定的相关性，FIB可作为心肌缺血再灌注相关炎症反应的预测因子。
ABSTRACT: Objective To investigate the correlation between fibrinogen (FIB) and early inflammatory response in patients with myocardial ischemia/reperfusion injury (MIRI) so as to explore the role of FIB in predicting early inflammation during MIRI. Methods Patients with acute myocardial infarction were treated by coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) according to their conditions, and MIRI was induced by PCI. Blood samples were collected before and 2 hours after operation. FIB, creatine kinase-MB (CK-MB), troponin I (cTnI), tumor necrosis factor-α (TNF-α), myeloperoxidase (MPO) and macrophage migration inhibitory factor (MIF) in the plasma were measured by enzyme-linked immunosorbent assay. Patients subjected with PCI were divided into three subgroups according to the level of plasma FIB; the correlation between FIB and the above-mentioned inflammatory cytokines was evaluated in the patients subjected to MIRI. Results The levels of serum FIB, CK-MB and cTnI in the patients subjected to PCI were higher than those in patients subjected to CAG (P<0.05 or P<0.01). Compared with patients in CAG, inflammatory cytokines including TNF-α, MPO and MIF after PCI were significantly increased (P<0.05). The inflammatory cytokines presented a rising trend with the increase of FIB level, and there was a certain correlation between FIB and inflammatory cytokines (r=0.625, 0.756, 0.864, P<0.01 or P<0.001). Conclusion Serum inflammatory cytokines are up-regulated after MIRI. There is a certain correlation between FIB and inflammatory cytokines in patients with MIRI. FIB can be regarded as a predictor of inflammation associated with MIRI