| Background: In recent years, with the improvement of people's standard of living, the acute cardiac events of coronary heart disease (CHD) increase year by year. Present studies have shown that inflammatory reaction is closely associated with CHD, especially with acute coronary syndrome (ACS). The instability of atherosclerotic plaque is the pathological basis of ACS, while inflammatory reaction and immune mechanism take part in the occurrence and development of atherosclerosis. Therefore, the research about proinflammatory cytokines may provide a new theoretical basis for the prevention and treatment of ACS. Tumor necrosis factor-α(TNF-α) is a non-specific important factor which mediated inflammatory reaction and immune regulation. It stems essentially from activated mononuclear macrophage, and it can cause "waterfall" inflammatory reaction in stress. Interleukin-18 (IL-18)is a kind of new pleiotropic proinflammatory cytokines and belongs to the IL-1 family. It comes from mononuclear macrophage in atherosclerotic plaque which can arise the inflammatory reaction by interferon-γ(IFN-γ). However, the role of TNF-α, IL-18 and total counts of white blood cell (WBC) in serum in ACS has been little reported.Object: In this study, we measured and compared serum levels of TNF-αand IL-18 in patients with AMI and UAP at admission and one week after admission to study the correlations between TNF-α/IL-18 and the total counts of WBC, and to investigate their clinical significance in ACS. In this way, we intend to explore the collective mechanism of ACS from the aspect of inflammatory cytokines and conduct a risk assessment in patients with ACS and we speculate that it may alleviate symptoms and reduce mortality by lower early elevated concentration of inflammatory cytokines.Methods: In the research 76 patients with chest pain, chest tightness or precordium discomfort were selected in the departments of cardiology and emergency in our hospital from September 2006 to February 2008. After admission selective coronary angiography were performed with all candidates. There were 60 patients of ACS, and they were divided into AMI group (30 cases) and UAP group (30 cases). Another 16 cases which were except for CHD by examining coronary angiography and clinical examinations were defined as control group. There was no significant difference among the three groups in the general data including age, sex and blood pressure. Serum levels of TNF-αwere measured through radioimmunity and serum concentration of IL-18 through ELISA. We measured their serum levels of WBC, glucose, uric acid, lipid, TNF-αand IL-18, and compared the results of different groups with each other. Serum levels of TNF-αand IL-18 were measured again for patients with ACS on the seventh day of admission, and we analysis the relevance of TNF-α/IL-18 and total counts of WBC. Patients with ACS were divided into groups of single, two and three vessel disease according to the results of coronary angiography.Results: 1. Compared with the control group, the total counts of WBC in AMI group and UAP group were significantly increased (P<0.01, P<0.05), and the total counts of WBC in AMI group were much higher than those in UAP group (P<0.01). The levels of uric acid in AMI group or UAP group were all significantly higher than those of control group (P<0.01, P<0.05), while no significant difference existed between AMI group and UAP group (P﹥0.05). 2. The serum levels of TNF-αin AMI group and UAP group were all obviously higher than those in control group (P<0.01, P<0.01), but there was no significant difference between AMI group and UAP group (P﹥0.05), and the serum levels of TNF-αon seventh day of admission were significantly lower than those on admission in AMI group and UAP group (P<0.05, P<0.05); Compared with the control group, the serum levels of IL-18 in AMI group and UAP group were significantly increased (P<0.01, P<0.01), and the serum levels of IL-18 in AMI group were higher than those in UAP group (P<0.05), and the serum levels of IL-18 on seventh day of admission were significantly lower than those on admission in AMI group and UAP group (P<0.01, P<0.01). 3. In AMI group and UAP group, there was a positive correlation between the serum levels of TNF-αand total counts of WBC (r=0.892, P<0.01), and a positive correlation as well exists between the serum levels of IL-18 and total counts of WBC (r=0.876, P<0.01). 4. There was no significant difference of the serum levels of TNF-αin the groups of single, two and three vessel disease; Compared with group of single and two vessel disease, the serum levels of IL-18 were significantly increased in the group of three vessel disease (P<0.01, P<0.05); Compared with single and two vessel disease, the total counts of WBC were obviously increased in three vessel disease (P<0.01, P<0.05). 5. In AMI group, single vessel disease group(7 cases accout for 23.3%), two vessel disease group (8 cases accout for 26.7%), three vessel disease group (15 cases accout for 50%), and the results indicated that three vessel disease was much higher than single vessel disease in AMI group (P<0.05). The proportion of criminal vasculars: LAD﹥RCA﹥LCX﹥LM.Conclusions: As inflammatory cytokines, TNF-α, IL-18, WBC and uric acid may all take part in the development of ACS and they have certain reference value for patients with ACS. The serum levels of TNF-αand IL-18 both have positive correlations with WBC, and our research shows that TNF-αand IL-18 may be the useful indicators to reflect changes in acute inflammation reaction. It indicates that the level of IL-18 was correlated with severity of coronary artery disease and it may be an important risk assessment predictor of inflammation for ACS.Above all, inflammatory reaction is closely associated with ACS, TNF-αand IL-18 may be markers of diagnosis and evaluate the risk of patients with ACS, and their specific roles in ACS still need further substantial clinical studies.
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