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目的:探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血Th1/Th2漂移与冠脉病变特点及胸痹虚实证候的相关性。方法:选取2010年5月～9月在山东省立医院及山东中医药大学第二附属医院心脏内科病房就诊行经皮冠状动脉造影(coronary arteriography,CAG)的患者66例,包括不稳定型心绞痛(unstable angina,UAP)患者22例、急性心肌梗死(acute myocardial infarction,AMI)患者11例、稳定型冠心病(SAP)患者33例,健康对照组20例。所有纳入对象均应用ELISA监测血干扰素γ(interferon-γ,IFN-γ)、白介素2(interleukin-2,IL-2)、白介素4(in-terleukin-4,IL-4)、白介素10(interleukin-10,IL-10)水平。冠状动脉造影采用Gensini积分、冠脉病变支数分析冠脉病变特点,并进行胸痹的辩证分型。结果:①UAP组、AMI组患者IFN-γ、IL-2水平较SAP、正常对照组有显著升高(P<0.05),且存在AMI组>UAP组>SAP组,然而,各组间IL-4、IL-10水平均无明显差异。②ACS组Gensini积分与SAP组比较有显著差异。UAP组、AMI组、SAP组患者IFN-γ、IL-2水平与Gensini积分均呈显著正相关;IL-4、IL-10水平与Gensini积分均呈负相关。③1支病变组与2支病变组之间IFN-γ、IL-2水平均无显著差异,但均较3支病变组细胞因子水平低(P<0.05)。2支病变组与3支病变组之间IL-4、IL-10水平均无显著差异,但均较1支病变组细胞因子水平低(P<0.05)。④中医虚证组IL-2、IFN-γ水平及Genisi积分均较实证组明显增高(P<0.05)。结论:①血Th1/Th2向Th1方向的漂移与ACS发生有关,与冠脉病变的程度是相关的。②虚证患者冠脉病变程度较实证患者严重。③IFN-γ、IL-2水平增高,可作为中医胸痹虚证微观辨证指标。
Objective: To investigate the relationship between the Th1 / Th2 shift in blood and the characteristics of coronary lesions and the syndromes of chest and abdomen syndrome in patients with acute coronary syndrome (ACS). Methods: Sixty-six patients with coronary arteriography (CAG) were enrolled in the Department of Cardiology of Shandong Provincial Hospital and the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from May to September in 2010, including unstable angina pectoris unstable angina (UAP), 22 patients with acute myocardial infarction (AMI), 33 patients with stable coronary heart disease (SAP) and 20 healthy controls. All patients were enrolled in this study. The levels of IFN-γ, IL-2, IL-4, IL-10 and IL- interleukin-10, IL-10) levels. Coronary angiography using Gensini score, coronary artery lesion characteristics of coronary lesions, and the dialectical classification of chest paralysis. Results: ① The levels of IFN-γ and IL-2 in UAP group and AMI group were significantly higher than those in SAP group and normal control group (P <0.05), and AMI group> UAP group> SAP group. However, 4, IL-10 levels were no significant difference. ② ACS group Gensini score compared with the SAP group were significantly different. The levels of IFN-γ and IL-2 in UAP group, AMI group and SAP group were positively correlated with Gensini score. The levels of IL-4 and IL-10 were negatively correlated with Gensini score. There was no significant difference in the levels of IFN-γ and IL-2 between the 1-vessel lesion group and the 2-vessel lesion group, but all of them were lower than the 3-vessel lesion group (P <0.05). There was no significant difference in the levels of IL-4 and IL-10 between the 2-vessel lesion group and the 3-vessel lesion group, all of which were lower than that of 1 vessel disease group (P <0.05). ④ The levels of IL-2, IFN-γ and Genisi in TCM deficiency group were significantly higher than those in empirical group (P <0.05). Conclusions: ① The shift of Th1 / Th2 to Th1 is related to the occurrence of ACS, and is related to the degree of coronary artery disease. ② deficiency of coronary artery disease patients with more serious evidence. ③IFN-γ, IL-2 levels increased, can be used as micro-syndrome differentiation of TCM syndromes.