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目的:通过检测急性中毒性心肌损害患者不同时期血清肿瘤坏死因子-a(TNF-a)、白细胞介素-6(IL-6)及C-反应蛋白(CRP)的水平,探讨炎性细胞因子在中毒性心肌损害早期诊断及病情评估中的应用价值。方法:选择2008年7月至2011年3月于我院救治的88例急性中毒性心肌损害患者为研究对象。分别于入院第1、7和14天检测其血清中TNF-a、IL-6及CRP的浓度,与健康对照组进行比较,并进行组间比较,探明TNF-a、IL-6及CRP随病程的变化趋势。同时检测患者血清中的肌酸激酶同工酶(CK-MB)水平,并将二者的变化趋势进行比较,从而明确炎性细胞因子水平的变化对中毒性心肌损害早期诊断的价值及其在病情评估方面的作用。结果:中毒性心肌损害组患者入院第1天血清中TNF-a、IL-6及CRP含量明显高于对照组,其结果有极显著的统计学差异(P<0.01),入院第7和14天患者血清中TNF-a、IL-6及CRP含量与对照组相比无明显差异(P>0.05);入院第1天的检测结果分别与第7天和第14天的结果相比,均有统计学差异(P<0.05),第7天和第14天的检测结果相比,无统计学差异(P>0.05);即上述患者血清中的TNF-a、IL-6及CRP水平于入院第1天升高,第7天恢复至正常水平。同时检测的血清CK-MB水平也于入院第1天升高,第7天恢复至正常水平,第14天亦与正常对照组相比无明显差异,故提示急性中毒性心肌损害患者血清TNF-a、IL-6及CRP水平与CK-MB水平随病程的变化趋势相符。结论:在中毒性心肌损害发病早期TNF-a、IL-6及CRP可作为诊断指标,且可作为判断心肌损害程度及预后的指标之一。
Objective: To investigate the levels of serum tumor necrosis factor-α (TNF-a), interleukin-6 (IL-6) and C-reactive protein (CRP) in patients with acute toxic myocardial damage at different stages, In the early diagnosis of toxic myocardial damage and disease evaluation value. Methods: A total of 88 acute poisoning patients with myocardial damage treated in our hospital from July 2008 to March 2011 were selected as the study subjects. The concentrations of TNF-a, IL-6 and CRP in serum were detected on the 1st, 7th and 14th day after admission, respectively, and compared with the healthy control group. The levels of TNF-a, IL-6 and CRP With the course of the trend. At the same time, the level of creatine kinase MB in serum was detected, and the change trend of the two was also compared to clarify the value of the change of inflammatory cytokines in the early diagnosis of toxic myocardium damage The role of disease assessment. Results: The levels of TNF-a, IL-6 and CRP in the serum of patients with toxic myocardial damage were significantly higher than those of the control group on the first day of admission, and there was a statistically significant difference (P <0.01) The levels of TNF-a, IL-6 and CRP in the serum of patients on day 1 were not significantly different from those of the control group (P> 0.05). The results of the first day of admission were respectively compared with the results of the 7th and 14th days (P <0.05). There was no significant difference between the 7th day and the 14th day (P> 0.05). The serum levels of TNF-a, IL-6 and CRP Admitted to the first day of the rise, the first 7 days returned to normal levels. At the same time, the level of serum CK-MB in serum was also elevated on the first day of admission, returned to the normal level on the 7th day, and no significant difference compared with the normal control group on the 14th day, which indicated that the level of serum TNF- a, IL-6 and CRP levels and CK-MB levels consistent with the course of the trend. CONCLUSION: TNF-a, IL-6 and CRP may play an important role in the diagnosis of early stage of toxic myocardial damage, and may be used as an index to judge the degree of myocardial damage and prognosis.