Kosmala Wojciech, Przewlocka-Kosmala Monika, Mazurek Walentyna
Cardiology Department, Medical University, Wroclaw, Poland.
Int J Cardiol. 2005 Jun 8;101(3):449-56. doi: 10.1016/j.ijcard.2004.03.067.
Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) can potentiate heart muscle damage during acute myocardial infarction (AMI). Whether changes in their plasma levels after AMI are dependent on the presence of myocardial viability is unclear. The aim of the study was to estimate the relation of time course of plasma TNF-alpha and IL-6 and the presence of reversible and irreversible myocardial dysfunction in patients early after AMI treated thrombolytically.
Patients (54; mean age 60.4 +/- 11.7 years) with AMI plasma TNF-alpha and IL-6 were evaluated on the 2nd, 10th and 30th day after thrombolysis. Based on the response of dysfunctional segments of myocardium during dobutamine stress echocardiography performed on the 10th day, patients were divided into four groups: A, sustained improvement in contractility; B, biphasic (improvement followed by worsening); C, only worsening; D, no change. Twenty-two healthy persons served as controls.
On the 2nd day, all four groups of patients demonstrated increased levels of TNF-alpha and IL-6 and did not differ among one another regarding both cytokines. On the 10th day, plasma TNF-alpha and IL-6 decreased in each group and were the lowest in group A, intermediate in group B and the highest in groups C and D. On the 30th day, both cytokines were not different among all studied groups.
Elevated plasma TNF-alpha and IL-6 early after AMI decreased more quickly in patients with dysfunctional myocardium comprising not only necrotic but also viable segments. This decline is attenuated by the presence of residual ischemia.
肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）等促炎细胞因子可在急性心肌梗死（AMI）期间加重心肌损伤。AMI后其血浆水平的变化是否取决于心肌存活情况尚不清楚。本研究的目的是评估溶栓治疗的AMI患者早期血浆TNF-α和IL-6的时间进程与可逆性和不可逆性心肌功能障碍之间的关系。
对54例（平均年龄60.4±11.7岁）AMI患者在溶栓后第2天、第10天和第30天评估血浆TNF-α和IL-6。根据第10天行多巴酚丁胺负荷超声心动图时心肌功能障碍节段的反应，将患者分为四组：A组，收缩力持续改善；B组，双相变化（先改善后恶化）；C组，仅恶化；D组，无变化。22名健康人作为对照。
第2天，四组患者的TNF-α和IL-6水平均升高，两组细胞因子水平无差异。第10天，每组血浆TNF-α和IL-6均下降，A组最低，B组中等，C组和D组最高。第30天，所有研究组的两种细胞因子水平无差异。
AMI后早期血浆TNF-α和IL-6升高在不仅包含坏死节段而且包含存活节段的功能障碍心肌患者中下降更快。残余缺血的存在会减弱这种下降。
