Zemskov A M, Alekhina O D, Zemskov V M, Zemskov M A, Zoloedov V I
Ter Arkh. 2008;80(1):32-7.
To ascertain the role of typical reactions of the immune system in early prognostication of congestive cardiac failure (CCF) in patients with primary transmural anterior myocardial infarction (MI) in the postinfarction period.
Typical immune reactions were studied for a year after the disease onset. A total of 228 males aged 40-60 years (mean age 53.8 +/- 4.1 years) with primary Q-wave MI of anterior location without accompanying diseases or allergy, with comparable volumes of myocardial necrosis were included in the trial. The control group consisted of 35 healthy men aged 40 to 60 years (mean age 52.9 +/- 4.3 years). Morphofunctional characteristics of the heart were studied by Doppler echocardiography within a month since MI onset and a year after MI. Immunological examination performed on MI day 1, 15 and 25 included determination by tests of the first-second level by R. V. Petrov of the count of leukocytes, lymphocytes, T-cells, T-helpers, T-suppressors (CD3+, CD4+, CD9+), zero lymphocytes, immunoglobulins, circulating immune complexes, complement by 50% hemodialysis, phagocyte index and count. Statistical processing included parametrical and non-parametrical criteria, correlation-regression analysis, criterion chi-square. The index of diagnostic significance Kj was calculated. Also, frequency and graphic analyses were made.
The analysis of immunological disorders in patients with five variants of primary Q-wave MI (LV aneurism with moderate dilatation of the cavity, aneurism of the heart in combination with L V cavity dilation with CDR >60 mm and development of mitral regurgitation >2 degrees, prevalence of LV diastolic dysfunction, progressive dilatation of the heart cavities with development of mitral of degree 2-3 and tricuspidal of degree 1-2 insufficiency, compensated hemodynamics without essential changes of the LV and LA) has established the same type of immune reactions to the pathological process manifesting with a fall in the count of absolute and relative count of lymphocytes, T-cells, T-helpers, B-lymphocytes, complement, phagocytic index, suppression index. These changes were accompanied with increased count of T-suppressors, zero-lymphocytes, CIC, immunoglobulins, leucointoxication index. The immunological examination of the patients showed that all morphofunctional variants of the myocardium correlated with suppression of immune reaction in the following order: compensated aneurism of the LV (18 parameters), diastolic dysfunction of the LV (11), progressive dilatation of the heart cavities (8), aneurism of the LV (6), marked dilatation of the heart cavities (4). Patients with pronounced dynamics of the regenerative processes had suppression of cellular immunity of the second degree, in positive hemodynamics there were characteristic changes in T-suppressor link of immunity in accumulation of zero lymphocytes. Patients with poor outcome of primary Q-MI had the same formula of immune parameters: reduced count of T-helpers, high values of T-suppressors and CIC. Thus, the data show that low count of T-helpers, common T-cells, high level of T-suppressors or zero-cells during post-MI month 1 are related with compensated regeneration of the cardiac muscle. If the patients have deviation of the regulatory index and accumulation of CIC, they have poor prognosis. Regarding the time since MI (1, 15 or 25 days), the following regulation was seen: patients with compensated hemodynamics have 4 decreased and 1 increased parameters of immune status; patients with pathological myocardial remodeling have stimulation of at least 5-6 parameters of the immune status.
Myocardial remodeling of the LV proceeds within the first year after development of myocardial necrosis; outcomes of myocardial restoration correlate with severity of immune disorders forming 2-3 weeks after MI, suppression of cell reactions agrees with compensated hemodynamics; accumulation of CIC in blood points to the risk of pathological remodeling of the left ventricle and post-MI cardiac failure.
确定免疫系统的典型反应在原发性透壁性前壁心肌梗死（MI）患者梗死后期充血性心力衰竭（CCF）早期预后中的作用。
在疾病发作后对典型免疫反应进行了为期一年的研究。共有228名年龄在40 - 60岁（平均年龄53.8 +/- 4.1岁）的男性纳入试验，这些男性患有原发性前壁Q波MI，无伴随疾病或过敏，心肌坏死体积相当。对照组由35名年龄在40至60岁（平均年龄52.9 +/- 4.3岁）的健康男性组成。在MI发作后一个月内及MI后一年，通过多普勒超声心动图研究心脏的形态功能特征。在MI第1天、第15天和第25天进行的免疫学检查包括通过R. V. Petrov的一二水平测试测定白细胞、淋巴细胞、T细胞、T辅助细胞、T抑制细胞（CD3 +、CD4 +、CD9 +）、零淋巴细胞、免疫球蛋白、循环免疫复合物、50%血液透析补体、吞噬细胞指数和计数。统计处理包括参数和非参数标准、相关回归分析、卡方检验。计算诊断意义指数Kj。还进行了频率和图形分析。
对原发性Q波MI的五种变体（左心室瘤伴中度腔扩张、心脏瘤合并左心室腔扩张且CDR > 60 mm及二尖瓣反流> 2度、左心室舒张功能障碍普遍存在、心脏腔逐渐扩张伴二尖瓣2 - 3度和三尖瓣1 - 2度关闭不全、代偿性血流动力学且左心室和左心房无本质变化）患者的免疫紊乱分析表明，对病理过程的免疫反应类型相同，表现为淋巴细胞、T细胞、T辅助细胞、B淋巴细胞、补体、吞噬细胞指数、抑制指数的绝对计数和相对计数下降。这些变化伴随着T抑制细胞、零淋巴细胞、CIC、免疫球蛋白、白细胞中毒指数计数增加。对患者的免疫学检查表明，心肌的所有形态功能变体与免疫反应抑制按以下顺序相关：左心室代偿性瘤（18项参数）、左心室舒张功能障碍（11项）、心脏腔逐渐扩张（8项）、左心室瘤（6项）、心脏腔明显扩张（4项）。再生过程动态明显的患者有二度细胞免疫抑制，血流动力学正常时免疫的T抑制环节有特征性变化，即零淋巴细胞积聚。原发性Q - MI预后不良的患者具有相同的免疫参数公式：T辅助细胞计数减少，T抑制细胞和CIC值高。因此，数据表明，MI后第1个月T辅助细胞、普通T细胞计数低，T抑制细胞或零细胞水平高与心肌的代偿性再生有关。如果患者调节指数偏差且CIC积聚，则预后不良。关于MI后的时间（1天、15天或25天），观察到以下规律：血流动力学代偿的患者免疫状态参数4项降低，1项升高；心肌病理重塑的患者免疫状态至少5 - 6项参数受到刺激。
左心室心肌重塑在心肌坏死发生后的第一年内进行；心肌恢复的结果与MI后2 - 3周形成的免疫紊乱严重程度相关，细胞反应抑制与代偿性血流动力学一致；血液中CIC的积聚表明左心室病理重塑和MI后心力衰竭的风险。
