TNF-a与sCD40L在AMI患者PCI术后相关并发症中的临床意义邢永生韩明磊王鹏飞金卫东杨树涵王成侯永兰刘艳宾刘振崔佳佳(新乡市中心医院心血管内一科河南省新乡市453000通讯作者:邢永生Email:xingys@people)摘要目的通过对比急性心肌梗死(Acutemyocardialinfarction,AMI)患者血清肿瘤坏死因子a(Tumornecrosisfactor-a,TNF-a)与可溶性CD40配体(Solubleclusterofdifferentiation40ligand,sCD40L)术前及术后的浓度变化，探讨其在AMI患者经皮冠状动脉介入治疗(Percutaneouscoronaryintervention,PCI)术示相关并发症中的作川。方法采丿I］固相夹心酶联免疫法测定75例AMI患者发病6-12小时内(PCI术前)及术后24小时血浆TNF-a与sCD40L浓度，同时，根据住院期间病情AMI患者分为3组：死亡组、并发症组及无并发症组。结果1.死亡组术前血浆TNF-a(206.4±57.58)ng/L与sCD40L(10.29±0.89)mg/L的浓度明显高于并发症组TNF-a(158.03±34.98)ng/L与sCD40L(7.32土1.83)mg/L及无并发症纽.TNF-a(95.21±24.08)ng/L与sCD40L(5.18±0.41)mg/L,差异均有统计学意义(PO.01),并发症纟R也明显高于无并发症纟R,差异也有统计学意义(P<0.05)；术后死亡组血浆的浓度明显高于并发症纟ft及无并发症纟ft,差异均有统计学意义(P<0.01)；2.各组木身术前及术后对比死亡组及并发症组术后明显高于术前，差异有统计学意义(P<0.05),无并发症术前术后对比，羌异无统计学意义(P>0.05)。结论TNF-«与sCD40L与AMI患者PCI术后并发症的发生相关，其术前及术后血清浓度越高，近期发生严重并发症的可能性越大，二者测定可作为判断AMI患者急诊PCI术后近期预后的指标。关键词心肌梗死；经皮冠状动脉介入治疗；肿瘤坏死因了a；可溶性CD40配体：R541.4文献标识码：AClinicalsignificanceofTNF-aandsCD40LincomplicationofAMIpatientsafterPCIXingyong-shengHanming-leiWangpeng-fei激nwei-dongYangshu-hanWangchengHouyong-lanLiuyan-binLiuzhenCui激a激a(firstdepartmentofCardiology,centralhospitalofXinxiangcity,Henanprovince,453000)AbstractObjectiveToinvestigatetheclinicalsignificanceofTNF-aandsCD40LincomplicationofAMIpatientsafterPCIbycomparedthechangingofpre-andpost-operationplasmaTNF-aandsCD40LinpatientswithAMLMethodsPlasmiclevelsofTNF-aandsCD40Lwereassaiedwithintheonset6〜12handpost-operation24hbyadoptedELISAin75AMIpatients・TheAMIpatientsweredividedinto3sub-groups:thedeathgroup,thecomplicationgroupandthenocomplicationgroup・Results1.PlasmiclevelofTNF206.4±57.58)ng/LandsCD40L(10.29+0.89)mg/LofthedeathgroupatprcopcrationwashigherthanTNF-a(1503±34.98)ng/LandsCD40L(7.32±1.83)mg/LofthecomplicationgroupandTNF-ci(95.21±24.08)ng/LandsCD40L(5.18±0.41)mg/Lofthenocomplictiongroup,thedifferenceswerestatisticallysignificance(P<0.05).PlasmiclevelofTNF-aandsCD40LofthedeathgroupafterPCIwasthehighest.2.Autologouscomparisonofeachgroupatpre-andpost-PCI,thedeathgroupandthecomplicationgroupwerehigherthanthepre-PCIlevel,thedifferenceswerestatisticallysignificance,butthedifferencesofthenocomplicationgroupwasnotstatisticallysignificance.ConclusionPlasmiclevelsofTNF-aandsCD40LwerecorrelativewiththeoccurrenceofthecomplicationsofAMIpatientsatpost-PCI,thehigherPlasmiclevelofTNF-aandsCD40L,themorethepossibilityoftheoccurreneeofseriouscomplications,thedetenninationofthebothinAMIpatientscanbeusedasshort-termprognosticindicatorsafteremergencyPCI.KEYWORDS:myocardialinfarction,Percutaneouscoronaryintervention,tumornecrosisfactor-alpha,Solubleclusterofdifferentiation40ligandAMI已成为我们国家所血临的重大公共卫生问题，随看人们生活水平和质量的提高，其发病年龄渐趋年轻，猝死率显著增加，尽管目前我们通过对传统危险因素“三高一吸烟"的控制，使冠心病死亡率有所下降，但这并不能解释所有冠脉事件，目前大量的国内外临床...