CMR及白细胞介素-6在急性ST段抬高型心肌梗死患者左心室不良重构预测中的研究进展  

Research progress on CMR andinterleukin-6 in predicting left ventricular adverse remodeling in patients with acute ST segment elevation myocardial infarction

作　　者：刘苏宁 张子倩 叶文颖 周莹 LIU Suning;ZHANG Ziqian;YE Wenying;ZHOU Ying(Department of Imaging,Xuzhou Medical University Affiliated Hospital Of Lianyungang,Lianyungang 222000,China)

机构地区：[1]徐州医科大学附属连云港医院影像科,连云港222000

出　　处：《磁共振成像》2025年第3期156-161,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：中华国际医学交流基金会SKY影像科研基金项目(编号:Z-2014-07-2101);连云港市卫生科技项目(编号:202007)。

摘　　要：ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)是一种伴有心肌损伤和左心室功能不全的严重心血管疾病。尽管直接经皮冠状动脉介入治疗(primary percutaneous coronary interventions,pPCI)能够迅速开放责任血管并提高生存率,但部分患者仍会经历左心室不良重构(adverse left ventricle remodeling,ALVR),进而影响长期预后。白细胞介素-6(interleukin-6,IL-6)作为一种关键的促炎细胞因子,在心血管疾病的发生和发展过程中发挥核心作用。急性心肌梗死后,IL-6参与炎症反应的启动、调节及维持,其作用具有双重性。一方面,IL-6可促进炎症因子的释放,有助于清除坏死组织并促进心肌修复;另一方面,IL-6水平过度升高可能导致炎症失控,引发心肌纤维化、心室重构及心功能下降,从而增加心血管不良事件的风险。心脏磁共振(cardiac magnetic resonance,CMR)作为评估心脏结构和功能的金标准,能够结合梗死面积、左心室射血分数(left ventricular functional,LVEF)和心肌应变等参数,对ALVR进行全面评估。因此,早期识别ALVR的风险因素对于改善患者预后至关重要。本综述旨在探讨CMR及IL-6在STEMI患者ALVR中的应用,以期未来研究可探索多模态影像融合、人工智能辅助分析以及针对IL-6的靶向治疗,以优化STEMI后ALVR的管理,提高患者长期预后。ST-segment elevation myocardial infarction(STEMI) is a serious cardiovascular disease associated with myocardial injury and left ventricular insufficiency.Although direct percutaneous coronary intervention(pPCI) rapidly opens the responsible vessel and improves survival,some patients still experience adverse left ventricular remodeling(ALVR),which in turn affects long-term prognosis.Interleukin-6(IL-6),a key pro-inflammatory cytokine,plays a central role in the development and progression of cardiovascular disease.After acute myocardial infarction,IL-6 is involved in the initiation,regulation,and maintenance of the inflammatory response,and its role is dual.On the one hand,IL-6 promotes the release of inflammatory factors,which helps to remove necrotic tissue and promote myocardial repair;on the other hand,excessively elevated levels of IL-6 may lead to uncontrolled inflammation,triggering myocardial fibrosis,ventricular remodeling,and decline in cardiac function,which increases the risk of adverse cardiovascular events.Cardiac magnetic resonance(CMR),as the gold standard for evaluating cardiac structure and function,is capable of comprehensively assessing adverse LV remodeling by combining parameters such as infarct size,left ventricular ejection fraction(LVEF) and myocardial strain.Therefore,early identification of risk factors for adverse LV remodeling is crucial for improving patient prognosis.The aim of this review is to explore the use of CMR and IL-6 in ALVR in patients with STEMI,with the hope that future studies may explore multimodal image fusion,artificial intelligence-assisted analysis,and targeted therapies for IL-6 in order to optimise the management of ALVR after STEMI and to improve the long-term prognosis of patients.

关 键 词：左心室不良重构 急性ST段抬高型心肌梗死 心脏磁共振 磁共振成像 心肌应变 白细胞介素 

分 类 号：R445.2[医药卫生—影像医学与核医学] R541.7[医药卫生—诊断学]