目的和背景：心脏疾病的病理生理过程通常是多种致病性和保护性因素共同参与、相互博弈的结果。急性冠状动脉综合征(Acute Coronary Syndrome, ACS)和急性心力衰竭(Acute Heart Failure, AHF)作为最常见的心脏急症，其发生、发展和预后与机体免疫机能紊乱的出现及其程度关系十分密切。Th17细胞是继Th1. Th2、Treg细胞以外新确认的又一类 CD4T细胞，其标志性细胞因子白介素-17 (IL-17 ) 已在多项免疫疾病研究中被证实是主要血管炎症因子，但国内外关于其在ACS和 AHF过程中所发挥作用的研究却发现IL-17呈现促进病情进展和抑制部分促炎因子生成的“双面性"，且与经典心脏病炎性因子干扰素-γ (IFN-γ ) 关系密切。该现象已经成为了当前心脏疾病研究领域的热点之一。我们对急诊ACS/AHF起病24小时内的患者进行血清中IL-17及 IFN-γ水平的检测,并进行全面的急性冠脉事件风险评分(GRACE评 分 )/Killp分级，同时完善心肌酶 、NT-ProBNP等的测定作为基准对照，分析IL-17与 IFN- γ及 ACS、AHF相关生物学标志物和其它检查指标(包括常规、生化、凝血相、血气、超声心动等)的相关性，并随访观患者的死亡、再发心梗、严重心律失常及再发心衰的情况，以期对IL-17与心脏急症发病过程及其预后的关系进行研究.
方法：选取我院及安贞医院2011年3月至2013年11月期间收入急诊抢救室并通过病史、体征、胸片、ECG、心肌标记物、NT-proBNP.彩色多普勒超声心动图等检查确诊为ACS或 AHF的患者(发病24小时内)共115例，其中ACS100例，AHF15例，我们还选取了年龄 相匹配的35例健康体检者及10例青年健康体检者作为对照。采用酶联免疫吸附测定
(ELISA)的方法进行血清IL-17 及血IFN-γ的检测。对于病例组，我们分别在患者急性发病后7 天、28天、3个月及6 个月时进行随访，根据患者随访时状况将因再发心梗、心衰或严重心律失常入院治疗以及任何疾病原因引起的死亡作为观察终点。获得的数据经过SPSS19.0 统计学软件进行处理。
实验结果：1、血清IL-17及 IFN-γ水平在整体ACS组中与正常对照组比较虽未见显著差异(34.65±28.89 VS 28.7 ± 17.126, 14.64±17.43 VS 10.10±11.38, P 分别为 0.398 和0.295), 但却显示出增高的趋势; 2、ACS患者血清IL-17水平与IFN-γ水平呈现显著正相关（R=0.891, P=0）, 而对照组中这种相关性也存在且其关联强度更高（R=0.989,40）。与其自身性别、年龄、BML CTNR NT-proBNP, CCr、既往有无慢性心脏疾病等因素无明显相关性（P 值均>0.05）。 3、IL-17及 IFN-γ 浓度与ACS患者6 个月内是否发生严重不良预后无明显相关,预后良好组与预后不良组相比差异不显著（35.43±34.362 VS 36.11 ±30.16, 3.90±18.985 VS 15.99±18.148, P 值分别为 0.687 和 0.668）. 4、IL-17在AHF组患者（15例）较正常对照组血清中的浓度显著升高（56.75±48.169 VS 28.7±17.126； P=0.017）；而 IFN-γ水平亦具有类似趋势但其差异性不显著（21.65±22.160 VS 10.10±11.378, P=0.092）。
结论：血清IL-17水平在ACS患者发病早期（24小时内）有升高趋势，但变化不显著，且其与患者年龄、BMK cTNI、NT-prOBNP, Ccr等无显著关联，也不能预测ACS患者6个月 内的预后；ACS患者及对照组血清IL-17与 IFN-γ水平明显高度正相关。小样本资料初步提示，IL-17在AHF组患者（15例）血清中的浓度显著升高,意义尚待阐明。

Background: Heart disease such as coronary atherosclerosis, myocarditis, heart function failure is mostly driven by both innate and adaptive immune responses to pathogenic factors. As the most common cardiac emergency of our subject, Acute Coronary Syndrome (ACS) and Acute Heart Failure (AHF), its occurrence, development and prognosis is closely associated with the immune disorders and its extent. Recently a new lineage of CD4+T cells, type 17 helper T (Thl7) cells is confirmed by foreign scholars. And multiple autoimmune disease research have proven it' s signature inflammatory cytokines production interleukin IL—17 is the major damage factor of vessels. IL—17 play a important role in the ACS and AHF process but contribute as "Double-dealers", and show close relationship with classic heart disease inflammatory factor IFN- gamma. The phenomenon has become hot spot in the field of heart disease research in present.
Methods: 115hospitalized patients(100 ACS and 15 AHF) were selected in our study . Physical examination, chest radiograph, ECG, examinations of myocardial infarction, NT-proBNP, color doppler echocardiography and other relevent examinations were performed to confirm the diagnosis of ACS or AHF. 35 healthy people were chosen as control group. Serum level of IL—17 and IFN- γ of these 160 subjects were assayed by ELISA kit. To study the relatioship between IL—17 and final diagnosis, disease severity, prognosis and other classic biological indicators such as IFN- Y , TNI, NTproBNP, etc, the work of follow-up was performed on 7day, 28day, 3 months and 6 months after acute attack. According to the follow-up results we defined the end of observation as recurrence of heart failure, malignant arrhythmia or myocardial infarction or any causes of death. All the results were analyzed by SPSS 19.0.
Results: 1. Circulating IL—17 and IFN-γ were detected in a subset of patients with ACS, AHF and outpatients without cardiac disease,but the ACS group and AHF group shows no significant difference from control group (P_ACS=0.398, p_AHF=0.295). We found the increasing trend of serum IL—17, IFN-γ concentration in the subgroup of ACS include UA, NSTEMI, STEMI compare to match group by observing data stem-and-leaf diagram, but further data analysis shows there is no significant difference compared with control group (UA vs Control Groups :P_IL-17=0.500, P_IFN-y =0.288 ; NSTEMI vs Control Groups:P_IL-17=0.062, P_IFN-γ=0.097;STEMIvs ControlGroups :P_IL-17=0.932, P_IFN-γ=0.985).
2.There is a strong correlationship between IL—17 and IFN-γ serum levels in patients with ACS or AHF (R=0.891, P=0). IL-17 has no correlation with other factors include Ccr, cTNI, NT-proBNP, BMI, gender, age, .whether suffering from chronic heart disease,etc.
3. There was no association between level of serum IL-17, IFN-Y and ACS short-term prognosis (P_IL-17=0.687, P_IFN_γ=0.668).
4. Level of serum IL-17 in AHF group are different significantly compare to match group(P=0.017)and the concentration is obviously higher; Level of serum IFN-γ in UA group Showed a similar trend but didn' t attain significant difference from control group (P=0.092) .
Conclusion: Early in the course «24hour) of ACS, there is no significant change of serum IL-17, IFN-Y level, and they couldn't predict the short-term prognosis of UA or other ACS patients. There was a strong correlation between IL-17 and IFN-γ plasma levels in patients group and match group. There was no association between level of serum IL-17, IFN-γ and ACS short-term prognosis. Level of serum IL-17 in AHF group are is obviously higher than match group.