NLRP3炎症小体与ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后心室重构的相关性  

Association of NLRP3 inflammatory and ventricular remodeling in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

作　　者：周静[1] 黄帅 安荣 高峰[1] 刘亦伟 赵莉[1] ZHOU Jing;HUANG Shuai;AN Rong;GAO Feng;LIU Yi-wei;ZHAO Li(Department of Cardiology,the Affiliated Hospital of Yanan University,Yanan,Shaanxi 716000,China)

机构地区：[1]延安大学附属医院心血管内科,陕西延安716000

出　　处：《岭南心血管病杂志》2022年第5期391-396,共6页South China Journal of Cardiovascular Diseases

基　　金：延安市科学技术研究发展计划项目(项目编号:2017KS-03);延安大学附属医院科学技术研究发展计划项目(项目编号:2021PT-06)。

摘　　要：目的探讨NLRP3炎症小体与ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后心室重构的相关性。方法选取2019年4月至2020年6月在延安大学附属医院东关分院120例STEMI并行PCI治疗的患者为研究对象,根据随访末(6个月)较PCI治疗后1周左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)增长率(△LVEDV)将PCI治疗后患者划分为心室重构组(△LVEDV≥20%,n=32)和非重构组(△LVEDV<20%,n=88)。观察两组患者术前静脉血外周血单个核细胞(peripheral blood mononuclear cells,PBMCs)中NLRP3蛋白、mRNA以及血浆中白细胞介素(interleukin,IL)-18、IL-1β的浓度。运用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析IL-18、IL-1β、NLRP3蛋白、NLRP3 mRNA表达量对心室重构发生的预测价值。结果(1)心室重构组患者NLRP3蛋白、mRNA、IL-18、IL-1β的浓度均显著高于对照组,差异有统计学意义(P<0.05)。(2)Logistic回归分析结果显示,IL-18(P=0.015)、IL-1β(P=0.033)、NLRP3蛋白(P=0.000)、NLRP3 mRNA表达量(P=0.040)为PCI治疗后患者发生心室重构的独立危险因素。(3)运用ROC分析了IL-18、IL-1β、NLRP3蛋白、NLRP3 mRNA表达量对STEMI患者PCI治疗后心室重构发生的预测价值,结果显示曲线下面积分别为0.759、0.787、0.689、0.709,敏感度分别为0.67、0.65、0.70、0.65,特异度分别为0.74、0.83、0.61、0.70。结论STEMI患者PCI治疗后心室重构的发生与PBMCs中NLRP3蛋白、NLRP3 mRNA、血浆中IL-18、IL-1β浓度的升高相关,上述指标对此类患者心室重构的发生有一定预测价值。Objectives To explore the relationship between NLRP3 inflammatory and ventricular remodeling in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods One hundred and twenty patients with STEMI who underwent PCI from April 2019 to June 2020 in The Affiliated Hospital of Yanan University were enrolled.According to the growth rate of the left ventricular end-diastolic volume(LVEDV)(LVEDV of 6 months after PCI compared with that of 1 week after PCI),the patients were divided into ventricular remod⁃eling group(LVEDV≥20%,n=32)and non-remodeling group(LVEDV<20%,n=88).The expressions of NLRP3 protein and mRNA in venous peripheral blood mononuclear cells(PBMCs)and the concentrations of interleukin(IL)-18 and IL-1βin plasma were observed in the two groups before operation.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of IL-18,IL-1β,NLRP3 protein and NLRP3 mRNA expression in ventricular remodeling.Results(1)The expression of NLRP3 protein,mRNA,concentrations of IL-18 and IL-1βin ventricular remodeling group were significantly higher than those in control group(P<0.05).(2)Logistic regression analysis showed that the expressions of IL-18,IL-1β,NLRP3 protein and NLRP3 mRNA were independent risk factors for ventricular remodeling after STEMI-PCI.(3)The results of ROC analysis suggested that the expressions of IL-18,IL-1β,NL⁃RP3 protein and NLRP3 mRNA have a certain value in predicting the occurrence of ventricular remodeling after PCI in patients with STEMI.Conclusions The occurrence of ventricular remodeling after PCI in patients with STEMI is related to the increased expression of NLRP3 protein,NLRP3 mRNA,plasma IL-18,and IL-1βin PBMCs.The above indexes have a certain predictive value for the occurrence of ventricular remodeling in this kind of patients.

关 键 词：心肌梗死 NLRP3炎症小体 血管成形术 经腔 经皮冠状动脉 心室重构 

分 类 号：R542.22[医药卫生—心血管疾病]