血浆白介素-1β3水平对ST段抬高性急性心肌梗死预后的影响  

Effect of the plasma interleukin-1β level on prognosis of patients with ST-segment elevation acute myocardial infarction

作　　者：高炎[1] 童国新[1] 冷建杭[1] 金建芬[1] 张邢炜[2] 王宁夫[1] 杨建敏[1] 叶显华[1] 周亮[1] 

机构地区：[1]杭州市第一人民医院心内科,南京医科大学附属杭州医院,杭州310006 [2]杭州师范大学附属医院、杭州市第二人民医院心内科

出　　处：《中华急诊医学杂志》2009年第8期819-825,共7页Chinese Journal of Emergency Medicine

基　　金：杭州市科技发展计划项目（2006533Q04）

摘　　要：目的研究入院时血浆白介素-1p（IL-1β）水平对行经皮冠脉介入治疗（PCI）的趼段抬高性急性心肌梗死（STEAMI）患者发生不良心脏事件是否具有预测价值。方法单中心前瞻性连续入选2006年3月至2008年3月住院的患者为研究对象，其中STEAMI96例（均为发病12h以内，均行直接PCI术），稳定性心绞痛（SAP）271例以及正常冠脉对照组148例。以ELISA法分别检测其血浆IL-1β水平。然后对所有STEAMI患者进行前瞻性随访，观察住院期间主要心脏事件（MACE）（包括心源性死亡，非致死性心梗，心力衰竭、心源性休克等）的发生情况。结果STEAMI患者血浆IL-1β水平高于稳定性心绞痛及冠脉正常对照组（P〈0．05）。住院期间共32例STEAMI患者发生MACE（其中男性23例，女性9例，年龄（75．44±13．45）岁。非参数分析显示PCI术后发生MACE的患者其IL-1β水平显著高于无MACE的患者（中位数[范围]26．52[12．01～155．244]pg/mL vs．2．157[0．433～83．021]pg／mL，P〈0．01）。Spearman’S相关分析显示IL-1β与肌钙蛋白I峰值水平呈显著正相关（r=0．353，P=0．004）。多因素Logistic回归显示IL-1β≥20pg／mL是sTEAMI患者住院期间发生MACE的独立危险因素（OR32．05，95％CI 4．28～240．15，P=0．1301）。结论本研究表明ST段抬高性急性心肌梗死患者入院时血浆IL-1β水平升高，而且血浆IL-1β水平是行PCI治疗的ST段抬高性急性心肌梗死患者住院期间发生主要不良心脏事件的独立预测炎症指标。Objective Atherosclerosis is widely accepted as a chronic inflammatory disease. Senan biomarkers for vulnerable plaques not only serve as diagnostic tools for the identification of patients with acute coronary syndrome, but also assist the identification of high-risk patients. However, the existing data are limited and conflicting. In the present study, we determined whether the plasma levels of interleukin-1β （IL-1β） are correlated with adverse cardiac outcomes in patients with ST-evaluate acute myocardial infarction （STEAMI） undergoing primary percutaneous coronary intervention （PCI）. Effect of the plasma intedeukin-1β level on prognosis of patients with ST-segment elevation acute myocardial infarction. Method This prospective single-center study included 96 patients with STEAMI with onset 〈 12 h who underwent primary PCI, 271 patients with stable angina pectoris （SAP） and 148 control subjects without coronary artery disease who were consecutively admitted to hospital between Mar, 2006 and Mar, 2008. Plasma IL-1β levels were measured by enzyme-linked immunosorbent assay in all subjects. The patients with STEAMI were then followed prospectively for the occurrence of major adverse cardiae events （MACE） （including cardiovascular death, non-fatal myocardial infarction, heart failure, and cardiogenie shock） during hospitalization. We determined the association between IL-1β levels with the risk of MACE using multivariate logistic regression. Results Compared with the SAP patients and control subjects, patients with STEAMI had higher levels of IL-1β （ P 〈 0.05）. During hospitalization, 32 patients （33.3%） experienced MACE [23 males, 9 females; age： （75.44 ±13.45） years]. In the STEAMI patients, IL-1β was elevated in patients with MACE compared with patients without MACE （median [range]： 26.52 [ 12.010 to 155.244] pg/mL vs 2.157 [0.433 to 83.021] pg/mL; P 〈 0.01） by non-parameter analysis. Significant and positive correlations between IL-Iβ and cardiac troponi

关 键 词：冠状动脉粥样硬化性心脏病 ST段抬高性急性心肌梗死 经皮冠脉介入 细胞因子 白介素-1Β 预后 

分 类 号：R542.22[医药卫生—心血管疾病]