Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Aachen, 52074 Aachen, Germany.
Clin Res Cardiol. 2012 Oct;101(10):815-27. doi: 10.1007/s00392-012-0465-x. Epub 2012 May 6.
To characterize the time course of tumor necrosis factor-α (TNF-α) serum levels along with myocardial perfusion and contractile function in patients with ST-segment elevation myocardial infarction (STEMI) and successful primary percutaneous coronary intervention (PCI).
Serum levels of TNF-α, interleukin 6 (IL-6), and C-reactive protein (CRP) were measured in 42 patients with STEMI before, one and 6 days after successful PCI. Myocardial perfusion was assessed by contrast-enhanced echocardiography (ceEcho), contractile function by unenhanced two-dimensional (2DE) and real-time three-dimensional echocardiography. In a subset of 18 patients, infarct size was quantified by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) on day six.
TNF-α serum levels were in the upper normal range within the first 12 h from symptom onset and increased continuously until day six, while IL-6 and CRP increased subsequently with a peak on day one after STEMI. Serum TNF-α on day one after PCI correlated with perfusion defects, wall motion abnormalities, and infarct size (ceEcho: r = 0.52, p = 0.005; 2DE: r = 0.56, p = 0.002; LGE-CMR: r = 0.83-0.86; p < 0.0001). Using multiple regression linear analysis, infarct size on day six was predicted by serum TNF-α 1 day after PCI (p = 0.006, adjusted R (2) 0.638).
Our data reflect the clinical significance of early TNF-α elevation in patients with STEMI and primary PCI (Controlled Clinical Trials number, NCT00529607).
描述 ST 段抬高型心肌梗死（STEMI）患者成功接受经皮冠状动脉介入治疗（PCI）后，肿瘤坏死因子-α（TNF-α）血清水平与心肌灌注和收缩功能的时间进程。
42 例 STEMI 患者于 PCI 成功前、后第 1 天及第 6 天，检测 TNF-α、白细胞介素 6（IL-6）和 C 反应蛋白（CRP）的血清水平。采用对比增强超声心动图（ceEcho）评估心肌灌注，二维（2DE）和实时三维超声心动图评估收缩功能。在 18 例患者亚组中，于第 6 天采用钆延迟增强心血管磁共振成像（LGE-CMR）定量梗死面积。
STEMI 发病后 12 小时内，TNF-α 血清水平处于正常上限范围内，并持续升高至第 6 天，而 IL-6 和 CRP 则随后升高，在 STEMI 后第 1 天达到峰值。PCI 后第 1 天的血清 TNF-α与灌注缺损、室壁运动异常和梗死面积相关（ceEcho：r=0.52，p=0.005；2DE：r=0.56，p=0.002；LGE-CMR：r=0.83-0.86；p<0.0001）。采用多元线性回归分析，第 6 天的梗死面积由 PCI 后第 1 天的血清 TNF-α预测（p=0.006，调整后的 R2为 0.638）。
我们的数据反映了 TNF-α 在 STEMI 患者接受 PCI 后的早期升高具有临床意义（临床试验注册号：NCT00529607）。
