IL-6、IL-27与ST段抬高型心肌梗死患者冠状动脉介入治疗预后的关系
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摘要
目的探讨白细胞介素6(IL-6)、白细胞介素27(IL-27)与急性ST段抬高型心肌梗死(STEMI)患者冠状动脉介入治疗预后的关系。方法纳入2015年1月至2016年12月在新疆维吾尔自治区人民医院接受冠状动脉介入治疗的初发STEMI患者,收集其临床资料及介入治疗前血液标本,采用酶联免疫吸附法检测血浆IL-6和IL-27水平。根据患者术后一年是否发生主要不良心血管事件(MACE)将其分为对照组和MACE组,利用多因素Logistic回归模型和受试者工作特征(ROC)曲线分析IL-6、IL-27与MACE发生的关系及其预测价值。结果 287例初发STEMI患者,男性179例(62.4%),年龄为61.37±9.83岁,其中57例发生MACE(19.9%)。MACE组患者年龄、Gensini评分、血浆IL-6和IL-27水平以及吸烟、糖尿病、双支/多支血管病变比例均显著高于对照组患者。Logistic回归分析显示,IL-6(OR=1.72,95%CI为1.50～2.15,P<0.001)和IL-27(OR=1.24,95%CI为1.11～1.42,P=0.001)是STEMI患者介入治疗一年期MACE发生的独立危险因素。IL-6和IL-27预测MACE的曲线下面积分别为0.701和0.690。结论 IL-6和IL-27是STEMI患者冠状动脉介入治疗后一年期MACE发生的独立危险因素,对患者临床结局具有一定的预测价值。
Aim To evaluate the prognostic value of plasma interleukin-6(IL-6) and interleukin-27(IL-27)level in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention(PCI).Methods Patients with STEMI diagnosed first time and underwent PCI in People's Hospital of Xinjiang Uygur Autonomous Region were consecutively enrolled from January 2015 to December 2016.Clinical data and blood samples before PCI were obtained from all patients.Plasma levels of IL-6 and IL-27 were measured by enzyme-linked immunosorbent assay.The patients were divided into two groups based on the occurrence of major adverse cardiovascular events(MACE) during 1-year follow-up after STEMI diagnosis.Logistic regression analysis was performed to evaluate the relationship between plasma IL-6 and IL-27 levels and the occurrence of MACE.The receiver operating characteristic(ROC) curve was applied to evaluate the predictive values of IL-6 and IL-27 on the occurrence of MACE.Results Among 287 patients with STEMI,179(62.4%) were males and the age was 61.37±9.83,57(19.9%) had MACE.Compared with controls,patients in MACE group were older with higher Gensini score,higher plasma IL-6 and IL-27 levels.The prevalence of smoking,diabetes,and two-or multi-vessel coronary artery disease were higher in MACE group in comparison to controls.Logistic regression analysis demonstrated that IL-6(OR=1.72,95% CI was 1.50～2.15,P<0.001)and IL-27(OR=1.24,95%CI was 1.11～1.42,P<0.001) were significantly independent predictors of MACE in STEMI patients undergoing PCI.The area under the ROC curve of IL-6 and IL-27 for predicting MACE were 0.701 and 0.690,respectively.Conclusion Plasma IL-6 and IL-27 levels were independent risk predictors for identifying the MACE of 1-year follow-up in patients with STEMI underwent PCI,indicating that they may help to assess the clinical outcomes for us.
Aim To evaluate the prognostic value of plasma interleukin-6(IL-6) and interleukin-27(IL-27)level in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention(PCI).Methods Patients with STEMI diagnosed first time and underwent PCI in People's Hospital of Xinjiang Uygur Autonomous Region were consecutively enrolled from January 2015 to December 2016.Clinical data and blood samples before PCI were obtained from all patients.Plasma levels of IL-6 and IL-27 were measured by enzyme-linked immunosorbent assay.The patients were divided into two groups based on the occurrence of major adverse cardiovascular events(MACE) during 1-year follow-up after STEMI diagnosis.Logistic regression analysis was performed to evaluate the relationship between plasma IL-6 and IL-27 levels and the occurrence of MACE.The receiver operating characteristic(ROC) curve was applied to evaluate the predictive values of IL-6 and IL-27 on the occurrence of MACE.Results Among 287 patients with STEMI,179(62.4%) were males and the age was 61.37±9.83,57(19.9%) had MACE.Compared with controls,patients in MACE group were older with higher Gensini score,higher plasma IL-6 and IL-27 levels.The prevalence of smoking,diabetes,and two-or multi-vessel coronary artery disease were higher in MACE group in comparison to controls.Logistic regression analysis demonstrated that IL-6(OR=1.72,95% CI was 1.50～2.15,P<0.001)and IL-27(OR=1.24,95%CI was 1.11～1.42,P<0.001) were significantly independent predictors of MACE in STEMI patients undergoing PCI.The area under the ROC curve of IL-6 and IL-27 for predicting MACE were 0.701 and 0.690,respectively.Conclusion Plasma IL-6 and IL-27 levels were independent risk predictors for identifying the MACE of 1-year follow-up in patients with STEMI underwent PCI,indicating that they may help to assess the clinical outcomes for us.
引文
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[15]Caselli C,De Graaf MA,Lorenzoni V,et al.HDL cholesterol,leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain[J].Atherosclerosis,2015,241(1):55-61.
[16]Hou H,Wang C,Sun F,et al.Association of interleukin-6 gene polymorphism with coronary artery disease:an updated systematic review and cumulative meta-analysis[J].Inflamm Res,2015,64(9):707-720.
[17]Interleukin-6 Receptor Mendelian Randomisation Analysis(IL6R MR)Consortium,Swerdlow DI,Holmes MV,et al.The interleukin-6 receptor as a target for prevention of coronary heart disease:a mendelian randomisation analysis[J].Lancet,2012,379(9822):1214-1224.
[18]Patterson CC,Smith AE,Yarnell JW,et al.The associations of interleukin-6(IL-6)and downstream inflammatory markers with risk of cardiovascular disease:the Caerphilly Study[J].Atherosclerosis,2010,209(2):551-557.
[19]Zhao L,Wang X,Yang Y.Association between interleukin-6 and the risk of cardiac events measured by coronary computed tomography angiography[J].Int J Cardiovasc Imaging,2017,33(8):1237-1244.
[20]Jong WM,Ten Cate H,Linnenbank AC,et al.Reduced acute myocardial ischemia-reperfusion injury in IL-6-deficient mice employing a closed-chest model[J].Inflamm Res,2016,65(6):489-499.
[21]Koltsova EK,Kim G,Lloyd KM,et al.Interleukin-27 receptor limits atherosclerosis in LDLR-/-mice[J].Circ Res,2012,111(10):1274-1285.
[22]Jin W,Zhao Y,Yan W,et al.Elevated circulating interleukin-27 in patients with coronary artery disease is associated with dendritic cells,oxidized low-density lipoprotein,and severity of coronary artery stenosis[J].Mediators Inflamm,2012,2012:506283.
[23]Lin Y,Huang Y,Lu Z,et al.Decreased plasma IL-35 levels are related to the left ventricular ejection fraction in coronary artery diseases[J].PLoS One,2012,7(12):e52490.
[24]Grufman H,Yndigegn T,Goncalves I,et al.Elevated IL-27 in patients with acute coronary syndrome is associated with adverse ventricular remodeling and increased risk of recurrent myocardial infarction and cardiovascular death[J].Cytokine,2018,DOI:10.1016/J.CYTO.2017.11.002.
[25]Kempe S,Heinz P,Kokai E,et al.Epstein-barr virus-induced gene-3 is expressed in human atheroma plaques[J].Am J Pathol,2009,175(1):440-447.
[2]Hausenloy DJ,Botker HE,Engstrom T,et al.Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction:trials and tribulations[J].Eur Heart J,2017,38(13):935-941.
[3]Ong SB,Hernandez-Resendiz S,Crespo-Avilan GE,et al.Inflammation following acute myocardial infarction:multiple players,dynamic roles,and novel therapeutic opportunities[J].Pharmacol Ther,2018,186:73-87.
[4]Wainstein MV,Mossmann M,Araujo GN,et al.Elevated serum interleukin-6 is predictive of coronary artery disease in intermediate risk overweight patients referred for coronary angiography[J].Diabetol Metab Syndr,2017,9:67.
[5]Su D,Li Z,Li X,et al.Association between serum interleukin-6 concentration and mortality in patients with coronary artery disease[J].Mediators Inflamm,2013,2013:726178.
[6]马丽,王燕,赵强,等.急性STEMI患者血尿酸与冠状动脉病变程度及直接PCI术后院内预后的关系[J].中华急诊医学杂志,2015,24(9):1035-1037.
[7]James PA,Oparil S,Carter BL,et al.2014 evidence-based guideline for the management of high blood pressure in adults:report from the panel members appointed to the Eighth Joint National Committee(JNC 8)[J].JAMA,2014,311(5):507-520.
[8]Pearson TA,Palaniappan LP,Artinian NT,et al.American Heart Association Guide for Improving Cardiovascular Health at the Community Level,2013 update:a scientific statement for public health practitioners,healthcare providers,and health policy makers[J].Circulation,2013,127(16):1730-1753.
[9]Liu F,Adi D,Xie X,et al.Prevalence of isolated diastolic hypertension and associated risk factors among different ethnicity groups in Xinjiang,China[J].PLoS one,2015,10(12):e0145325.
[10]Tavakolian Ferdousie V,Mohammadi M,Hassanshahi G,et al.Serum CXCL10 and CXCL12 chemokine levels are associated with the severity of coronary artery disease and coronary artery occlusion[J].Int J Cardiol,2017,233:23-28.
[11]Khan FY,Elouzi EB,Asif M.Acute acalculous cholecystitis complicating typhoid fever in an adult patient:a case report and review of the literature[J].Travel Med Infect Dis,2009,7(4):203-206.
[12]Fanola CL,Morrow DA,Cannon CP,et al.Interleukin-6and the risk of adverse outcomes in patients after an acute coronary syndrome:observations from the SOLID-TIMI 52(Stabilization of Plaque Using Darapladib-Thrombolysis in Myocardial Infarction 52)trial[J].J Am Heart Assoc,2017,6(10):E005637.
[13]Sukhija R,Fahdi I,Garza L,et al.Inflammatory markers,angiographic severity of coronary artery disease,and patient outcome[J].Am J Cardiol,2007,99(7):879-884.
[14]Opstad TB,Arnesen H,Pettersen AA,et al.Combined elevated levels of the proinflammatory cytokines IL-18 and IL-12 are associated with clinical events in patients with coronary artery disease:an observational study[J].Metab Syndr Relat Disord,2016,14(5):242-248.
[15]Caselli C,De Graaf MA,Lorenzoni V,et al.HDL cholesterol,leptin and interleukin-6 predict high risk coronary anatomy assessed by CT angiography in patients with stable chest pain[J].Atherosclerosis,2015,241(1):55-61.
[16]Hou H,Wang C,Sun F,et al.Association of interleukin-6 gene polymorphism with coronary artery disease:an updated systematic review and cumulative meta-analysis[J].Inflamm Res,2015,64(9):707-720.
[17]Interleukin-6 Receptor Mendelian Randomisation Analysis(IL6R MR)Consortium,Swerdlow DI,Holmes MV,et al.The interleukin-6 receptor as a target for prevention of coronary heart disease:a mendelian randomisation analysis[J].Lancet,2012,379(9822):1214-1224.
[18]Patterson CC,Smith AE,Yarnell JW,et al.The associations of interleukin-6(IL-6)and downstream inflammatory markers with risk of cardiovascular disease:the Caerphilly Study[J].Atherosclerosis,2010,209(2):551-557.
[19]Zhao L,Wang X,Yang Y.Association between interleukin-6 and the risk of cardiac events measured by coronary computed tomography angiography[J].Int J Cardiovasc Imaging,2017,33(8):1237-1244.
[20]Jong WM,Ten Cate H,Linnenbank AC,et al.Reduced acute myocardial ischemia-reperfusion injury in IL-6-deficient mice employing a closed-chest model[J].Inflamm Res,2016,65(6):489-499.
[21]Koltsova EK,Kim G,Lloyd KM,et al.Interleukin-27 receptor limits atherosclerosis in LDLR-/-mice[J].Circ Res,2012,111(10):1274-1285.
[22]Jin W,Zhao Y,Yan W,et al.Elevated circulating interleukin-27 in patients with coronary artery disease is associated with dendritic cells,oxidized low-density lipoprotein,and severity of coronary artery stenosis[J].Mediators Inflamm,2012,2012:506283.
[23]Lin Y,Huang Y,Lu Z,et al.Decreased plasma IL-35 levels are related to the left ventricular ejection fraction in coronary artery diseases[J].PLoS One,2012,7(12):e52490.
[24]Grufman H,Yndigegn T,Goncalves I,et al.Elevated IL-27 in patients with acute coronary syndrome is associated with adverse ventricular remodeling and increased risk of recurrent myocardial infarction and cardiovascular death[J].Cytokine,2018,DOI:10.1016/J.CYTO.2017.11.002.
[25]Kempe S,Heinz P,Kokai E,et al.Epstein-barr virus-induced gene-3 is expressed in human atheroma plaques[J].Am J Pathol,2009,175(1):440-447.