巨噬细胞移动抑制因子对ST段抬高型心肌梗死短期预后的影响
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摘要
目的评估巨噬细胞移动抑制因子(macrophage migration inhibition factor,MIF)预测ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者短期主要不良心血管事件(major adverse cardiovascular events,MACE)的价值。方法连续纳入2012年5月-2013年5月于新疆医科大学第一附属医院心脏中心重症监护室初次诊断为STEMI,并行急诊经皮冠状动脉介入治疗患者90例,作为STEMI组。同期纳入有非典型胸痛表现,但冠状动脉造影检查提示未见明显异常者44例,作为冠脉造影正常组。并纳入健康志愿者44例,作为健康对照组。对90例STEMI患者、44例冠脉造影正常者和44例健康志愿者进行血浆MIF浓度测定。研究终点为MACE发生。结果 STEMI患者血浆MIF水平高于对照组。在院期间发生MACE 10例,发生MACE组患者血浆MIF水平高于未发生MACE组[117.15(98.33～149.76) ng/mL vs 89.25 (67.63～113.22),P=0.010]。院内MACE发生的独立危险因素为:MIF (OR:1.10, 95%CI:1.02～1.77,P=0.038,每增加1 ng/mL)和肌酐(OR:1.04, 95%CI:1.01～1.08,P=0.006,每增加1μmol/L)。采用MIF预测住院患者MACE发生的受试者工作特征曲线下面积为0.77 (95%CI:0.64～0.89)。结论入院时单一的MIF检测可以作为预测STEMI患者在院MACE发生的有效生物标志物。
Objective To assess the capacity of Macrophage migration inhibitory factor(MIF) for predicting the short-term major adverse cardiovascular events(MACE) in patients with ST-segment elevation myocardial infarction(STEMI). Methods 90 patients with STEMI receiving emergency percutaneous coronary intervention were consecutively recruited in Coronary Care Unit at the Heart Center of The First Affiliated Hospital of Xinjiang Medical University from May 2012 to May 2013, setas our STEMI experimental group. Meanwhile, 44 patients with symptoms of atypical chest pain but no abnormality of left and right coronary arteries in coronary angiography were selected as normal coronary angiography group. 44 healthy volunteers were included as healthy control group. MIF plasma concentrations were measured in 90 STEMI patients, 44 normal coronary angiography patients and 44 healthy consecutive volunteers. The endpoints of the study were MACE. Results The plasma MIF level of STEMI patients was higher than that of the control group. During hospitalization, 10 MACE occurred. The plasma MIF level in patients with MACE during hospitalization, was higher than patients without MACE [117.15(98.33-149.76) ng/mL vs 89.25(67.63-113.22), P=0.010]. The independent predictors of in-hospital MACE were: admission MIF(OR:1.10 95% CI:1.02～1.77, P=0.038, per each ng/mL increase) and admission creatinine(OR:1.04 95%CI:1.01～1.08, per each umol/L increase). The area under the receiver operating characteristic(ROC) curve with MIF used to predict in-hospital MACE was 0.77(95% CI: 0.64～0.89). Conclusion A single MIF assay at admission could be a useful biomarker for early prediction of in-hospital MACE of patients with STEMI.
Objective To assess the capacity of Macrophage migration inhibitory factor(MIF) for predicting the short-term major adverse cardiovascular events(MACE) in patients with ST-segment elevation myocardial infarction(STEMI). Methods 90 patients with STEMI receiving emergency percutaneous coronary intervention were consecutively recruited in Coronary Care Unit at the Heart Center of The First Affiliated Hospital of Xinjiang Medical University from May 2012 to May 2013, setas our STEMI experimental group. Meanwhile, 44 patients with symptoms of atypical chest pain but no abnormality of left and right coronary arteries in coronary angiography were selected as normal coronary angiography group. 44 healthy volunteers were included as healthy control group. MIF plasma concentrations were measured in 90 STEMI patients, 44 normal coronary angiography patients and 44 healthy consecutive volunteers. The endpoints of the study were MACE. Results The plasma MIF level of STEMI patients was higher than that of the control group. During hospitalization, 10 MACE occurred. The plasma MIF level in patients with MACE during hospitalization, was higher than patients without MACE [117.15(98.33-149.76) ng/mL vs 89.25(67.63-113.22), P=0.010]. The independent predictors of in-hospital MACE were: admission MIF(OR:1.10 95% CI:1.02～1.77, P=0.038, per each ng/mL increase) and admission creatinine(OR:1.04 95%CI:1.01～1.08, per each umol/L increase). The area under the receiver operating characteristic(ROC) curve with MIF used to predict in-hospital MACE was 0.77(95% CI: 0.64～0.89). Conclusion A single MIF assay at admission could be a useful biomarker for early prediction of in-hospital MACE of patients with STEMI.
引文
[1] 于倩.巨噬细胞移动抑制因子对冠心病严重程度的评估价值[J].实用临床医药杂志,2017,21(1):180-181.
[2] MEMBERS W C,JNEID H,ANDERSON J L,et al.2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elev-ation myocardial infarction[J].Circulation,2012,126(7):875-910.
[3] BODY R,CARLEY S,MCDOWELL G,et al.Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay[J].J Am Coll Cardiol,2011,58(13):1332-1339.
[4] CHAN W,WHITE D A,WANG X Y,et al.Macrophage migration inhibitory factor for the early prediction of infarct size[J].J Am Heart Assoc,2013,2(5):e000226.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
[6] LOPES R D,LOKHNYGINA Y,HASSELBLAD V,et al.Methods of creat-ine kinase-MB analysis to predict mortality in patients with myocardial infarction treated with reperfusion therapy[J].Trials,2013,14:123.
[7] DAYAWANSA N H,GAO X M,WHITE D A,et al.Role of MIF in myocardial ischaemia and infarction:insight from recent clinical and experimental findings[J].Clin Sci Lond,2014,127:149-161.
[8] WHITE D A,FANG L,CHAN W,et al.Pro-inflammatory action of MIF in acute myocardial infarction via activation of peripheral blood mononuclear cells[J].PLoS One,2013,8(10):e76206.
[9] WANG J,TONG C,YAN X,et al.Limiting cardiac ischemic injury by pharmacological augmentation of macrophage migration inhibitory factor-AMP-activated protein kinase signal transduction[J].Circulation,2013,128:225-236.
[10] 胡露露,龚忠诚,陈青立,等.巨噬细胞移动抑制因子在唾液腺腺样囊性癌中的表达及临床意义[J].新疆医科大学学报,2018,41(4):481-485.
[11] KOGA K,KENESSEY A,POWELL S R,et al.Macrophage migration inhibitory factor provides cardioprotection during ischemia/reperfusion by reducing oxidative stress[J].Antioxid Redox Signal,2011,14:1191-202.
[12] STOPPE C,REX S,GOETZENICH A,et al.Interaction of MIF family proteins in myocardial ischemia/reperfusion damage and their influence on clinical outcome of cardiac surgery patients[J].Antioxid Redox Signal,2015,23:865-879.
[13] XU X,BUCALA R,REN J.Macrophage migration inhibitory factor deficiency augments doxorubicin-induced cardiomyopathy[J].J Am Heart Assoc,2013,2:e000439.
[14] LIEHN E A,KANZLER I,KONSCHALLA S,et al.Compartmentalized protective and detrimental effects of endogenous macrophage migrationinhibitory factor mediated by CXCR2 in a mouse model of myocardial ischemia/reperfusion[J].Arterioscler Thromb Vasc Biol,2013,33:2180-2186.
[15] ROSSELLO X,BURKE N,STOPPE C,et al.Exogenous administration of recombinant MIF at physiological concentrations failed to attenuate infarct size in a Langendorff perfused isolated mouse heart model[J].Cardiovasc Drugs Ther,2016,30:445-453.
[16] POHL J,RAMMOS C,TOTZECK M,et al.MIF reflects tissue damage rather than inflammation in post-cardiac arrest syndrome in a real life cohort[J].Resuscitation,2016,100:32-37.
[17] DENG X N,WANG X Y,YU H Y,et al.Admission macrophage migration inhibitory factor predicts long-term prognosis in patients with st elevation myocardial infarction[J].Eur Heart J Qual Care Clin Outcomes,2018,4(3):208-219.
[18] DENG F,ZHAO Q,DENG Y,et al.Prognostic significance and dynamic change of plasma macrophage migration inhibitory factor in patients with acute ST-elevation myocardial infarction[J].Medicine (Baltimore),2018,97(43):e12991.
[2] MEMBERS W C,JNEID H,ANDERSON J L,et al.2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/Non-ST-elev-ation myocardial infarction[J].Circulation,2012,126(7):875-910.
[3] BODY R,CARLEY S,MCDOWELL G,et al.Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay[J].J Am Coll Cardiol,2011,58(13):1332-1339.
[4] CHAN W,WHITE D A,WANG X Y,et al.Macrophage migration inhibitory factor for the early prediction of infarct size[J].J Am Heart Assoc,2013,2(5):e000226.
[5] 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2010,38(8):675-690.
[6] LOPES R D,LOKHNYGINA Y,HASSELBLAD V,et al.Methods of creat-ine kinase-MB analysis to predict mortality in patients with myocardial infarction treated with reperfusion therapy[J].Trials,2013,14:123.
[7] DAYAWANSA N H,GAO X M,WHITE D A,et al.Role of MIF in myocardial ischaemia and infarction:insight from recent clinical and experimental findings[J].Clin Sci Lond,2014,127:149-161.
[8] WHITE D A,FANG L,CHAN W,et al.Pro-inflammatory action of MIF in acute myocardial infarction via activation of peripheral blood mononuclear cells[J].PLoS One,2013,8(10):e76206.
[9] WANG J,TONG C,YAN X,et al.Limiting cardiac ischemic injury by pharmacological augmentation of macrophage migration inhibitory factor-AMP-activated protein kinase signal transduction[J].Circulation,2013,128:225-236.
[10] 胡露露,龚忠诚,陈青立,等.巨噬细胞移动抑制因子在唾液腺腺样囊性癌中的表达及临床意义[J].新疆医科大学学报,2018,41(4):481-485.
[11] KOGA K,KENESSEY A,POWELL S R,et al.Macrophage migration inhibitory factor provides cardioprotection during ischemia/reperfusion by reducing oxidative stress[J].Antioxid Redox Signal,2011,14:1191-202.
[12] STOPPE C,REX S,GOETZENICH A,et al.Interaction of MIF family proteins in myocardial ischemia/reperfusion damage and their influence on clinical outcome of cardiac surgery patients[J].Antioxid Redox Signal,2015,23:865-879.
[13] XU X,BUCALA R,REN J.Macrophage migration inhibitory factor deficiency augments doxorubicin-induced cardiomyopathy[J].J Am Heart Assoc,2013,2:e000439.
[14] LIEHN E A,KANZLER I,KONSCHALLA S,et al.Compartmentalized protective and detrimental effects of endogenous macrophage migrationinhibitory factor mediated by CXCR2 in a mouse model of myocardial ischemia/reperfusion[J].Arterioscler Thromb Vasc Biol,2013,33:2180-2186.
[15] ROSSELLO X,BURKE N,STOPPE C,et al.Exogenous administration of recombinant MIF at physiological concentrations failed to attenuate infarct size in a Langendorff perfused isolated mouse heart model[J].Cardiovasc Drugs Ther,2016,30:445-453.
[16] POHL J,RAMMOS C,TOTZECK M,et al.MIF reflects tissue damage rather than inflammation in post-cardiac arrest syndrome in a real life cohort[J].Resuscitation,2016,100:32-37.
[17] DENG X N,WANG X Y,YU H Y,et al.Admission macrophage migration inhibitory factor predicts long-term prognosis in patients with st elevation myocardial infarction[J].Eur Heart J Qual Care Clin Outcomes,2018,4(3):208-219.
[18] DENG F,ZHAO Q,DENG Y,et al.Prognostic significance and dynamic change of plasma macrophage migration inhibitory factor in patients with acute ST-elevation myocardial infarction[J].Medicine (Baltimore),2018,97(43):e12991.