血清IL-6、NT-proBNP水平对系统性硬化症无症状心肌纤维化的预测效能  

Predictive efficacy of serum IL-6 and NT-proBNP levels for asymptomatic myocardial fibrosis in systemic sclerosis

作　　者：王小冬[1] 刘坚[1] 丁振华[1] WANG Xiaodong;LIU Jian;DING Zhenhua(Department of Rheumatology,Lishui People's Hospital,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院风湿免疫科,浙江丽水323000

出　　处：《山东医药》2025年第4期108-111,118,共5页Shandong Medical Journal

基　　金：浙江省丽水市科技计划项目(2021SJZC028)。

摘　　要：目的探讨血清白细胞介素6(IL-6)、N末端脑钠肽前体(NT-proBNP)对系统性硬化症(SSc)无症状心肌纤维化的预测效能,为SSc患者心脏受累的早期诊断和干预提供参考依据。方法选取无典型心血管症状的SSc患者42例,通过心脏磁共振检查判断患者是否存在心肌纤维化。采集患者静脉血,采用ELISA法检测血清IL-6及NT-proBNP。收集患者一般资料以及SSc相关临床特征[SSc亚型、雷诺现象发生情况、肢端溃疡发生情况、改良Rodnan皮肤评分(mRSS)以及抗Scl-70抗体、抗着丝点抗体检测情况],比较发生与未发生无症状心肌纤维化SSc患者的临床资料,采用多因素Logistic回归分析SSc患者发生无症状心肌纤维化的影响因素。绘制受试者工作特征(ROC)曲线,分析血清IL-6、NT-proBNP单独及联合对SSc患者发生无症状心肌纤维化的预测效能。结果42例SSc患者中,发生心肌纤维化18例、未发生心肌纤维化24例;SSc无症状心肌纤维化发生率为42.85%。发生与未发生无症状心肌纤维化的SSc患者血清肌钙蛋白I、NT-proBNP、IL-6及mRSS比较差异均具有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,血清IL-6、NT-proBNP及mRSS是SSc患者发生无症状心肌纤维化的独立影响因素(P均<0.05)。ROC曲线分析结果显示,血清IL-6、NT-proBNP及mRSS单独预测SSc无症状心肌纤维化的曲线下面积(AUC)分别为0.841、0.670、0.836,3项指标联合预测SSc无症状心肌纤维化的AUC为0.940。结论SSc无症状心肌纤维化患者血清IL-6、NT-proBNP水平升高,是SSc患者发生无症状心肌纤维化的独立危险因素,两项指标与mRSS联合对SSc无症状心肌纤维化的预测价值较高。Objective To evaluate the predictive value of serum interleukin-6(IL-6)and N-terminal pro-brain natri-uretic peptide(NT-proBNP)in detecting asymptomatic myocardial fibrosis in patients with systemic sclerosis(SSc),there-by providing the references for early diagnosis and intervention for cardiac involvement in this population.Methods For-ty-two SSc patients without overt cardiovascular symptoms were enrolled.Myocardial fibrosis was assessed using cardiac magnetic resonance imaging(CMR).Serum IL-6 and NT-proBNP levels were measured via enzyme-linked immunosorbent assay(ELISA).Clinical and demographic data,including SSc subtype,Raynaud's phenomenon,digital ulcers,modified Rodnan skin score(mRSS),and anti-Scl-70/anti-centromere antibody status,were collected.Comparative analyses were performed between SSc patients with and without asymptomatic myocardial fibrosis.Multivariate Logistic regression was employed to identify independent predictors of myocardial fibrosis.Receiver operating characteristic(ROC)curve analysis was conducted to assess the diagnostic performance of IL-6,NT-proBNP,and their combination in predicting asymptomat-ic myocardial fibrosis.Results Among 42 SSc patients,18 cases had myocardial fibrosis and 24 cases did not;the inci-dence rate of asymptomatic myocardial fibrosis in SSc patients was 42.85%.Significant differences were observed in se-rum troponin I,NT-proBNP,IL-6,and mRSS between the fibrosis and non-fibrosis groups(all P<0.05).Multivariate analysis confirmed that IL-6,NT-proBNP,and mRSS were independent risk factors for asymptomatic myocardial fibrosis(all P<0.05).ROC analysis demonstrated that the area under the curve(AUC)of IL-6,NT-proBNP,and mRSS alone in predicting asymptomatic myocardial fibrosis was 0.841,0.670,and 0.836,respectively;the AUC of them combined was 0.940.Conclusions Serum IL-6 and NT-proBNP levels increase in SSc patients with asymptomatic myocardial fibrosis,and the elevated serum IL-6 and NT-proBNP levels are independent risk factors for asymptomatic myocardial fibro

关 键 词：系统性硬化症 心肌纤维化 白细胞介素6 N末端脑钠肽前体 磁共振成像 

分 类 号：R593.25[医药卫生—内科学]