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| 急性心肌梗死患者血浆白细胞介素22水平与冠状动脉病变程度和预后的关系 |
| 李天伦1,2,张中2,赵蓓2,殷召2,毛帅2,冯雪瑶2,张士丹2,周珮2,李奇恒2,张洁2,崔佳2,崔会平2,刘莉2,王守力1,2* |
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(1. 安徽医科大学第五临床医学院、安徽医科大学解放军306临床学院, 北京 100101;
2. 战略支援部队特色医学中心心血管内科, 北京 100101
*通信作者) |
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| 摘要: |
| 目的 探讨急性心肌梗死（AMI）患者血浆IL-22水平与冠状动脉病变程度和5年预后的相关性。方法 连续选择2014年10月至2016年12月在战略支援部队特色医学中心行急诊经皮冠状动脉介入治疗的AMI患者98例，分为ST段抬高型心肌梗死（STEMI）组58例和非ST段抬高型心肌梗死（NSTEMI）组40例；选择同期在战略支援部队特色医学中心心血管内科就诊且冠状动脉造影无异常者40例为对照组。采用Luminex液相芯片技术检测血浆细胞因子IL-22、IL-1β、IL-6、TNF-α水平。比较3组患者的基线资料及细胞因子水平，分析AMI患者IL-22与其他细胞因子的相关性。采用Pearson相关性分析及多元线性回归分析探究AMI患者的心脏外科与介入治疗狭窄冠状动脉研究（SYNTAX）积分与血浆IL-22等变量的关系，采用ROC曲线分析IL-22等指标对中高SYNTAX积分的预测能力，采用二分类logistic回归分析研究AMI患者出院后5年内主要不良心脑血管事件（MACCE）发生的危险因素。结果 STEMI、NSTEMI组和对照组患者年龄、性别、吸烟史等基线资料差异均无统计学意义（P均>0.05）；STEMI、NSTEMI组有冠心病家族史患者的比例及空腹血糖、超敏C反应蛋白、脑钠肽水平均高于对照组（P均<0.05），高密度脂蛋白胆固醇水平及左室射血分数（LVEF）均低于对照组（P均<0.05）。STEMI、NSTEMI组患者血浆IL-22、IL-1β、IL-6和TNF-α水平均高于对照组（P均<0.05）。AMI患者血浆IL-22水平与IL-1β（r＝0.793，P＝0.001）、IL-6（r＝0.880，P<0.001）、TNF-α（r＝0.840，P<0.001）水平呈正相关；SYNTAX积分与IL-22（r＝0.478，P＝0.001）、IL-6（r＝0.242，P＝0.017）、年龄（r＝0.217，P＝0.032）和心肌肌钙蛋白I（r＝0.261，P＝0.010）呈正相关，与LVEF（r＝－0.224，P＝0.034）呈负相关。多元线性回归分析显示，IL-22（β＝0.269，P＝0.023）、年龄（β＝0.236，P＝0.016）、LVEF（β＝－0.235，P＝0.023）是SYNTAX积分的影响因素。ROC曲线分析显示，IL-22对中高SYNTAX积分的预测能力（AUC＝0.760，95% CI 0.656～0.863，P＝0.001）高于年龄（AUC＝0.612，95% CI 0.478～0.746，P＝0.112）和LVEF（AUC＝0.628，95% CI 0.485～0.770，P＝0.070）。二分类logistic回归分析显示，SYNTAX积分及血浆IL-22水平与AMI患者出院后5年MACCE发生无关。结论 血浆IL-22水平与AMI相关，可反映冠状动脉病变的严重程度，对于AMI患者病情判断有较好的预测价值，与患者预后的关联尚需进一步验证。 |
| 关键词: 急性心肌梗死 白细胞介素22 冠状动脉病变 SYNTAX积分 主要不良心脑血管事件 |
| DOI：10.16781/j.CN31-2187/R.20210676 |
| 投稿时间：2021-07-07修订日期：2021-09-24 |
| 基金项目: |
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| Correlation of plasma interleukin-22 level with severity of coronary artery disease and prognosis in patients with acute myocardial infarction |
| LI Tian-lun1,2,ZHANG Zhong2,ZHAO Bei2,YIN Zhao2,MAO Shuai2,FENG Xue-yao2,ZHANG Shi-dan2,ZHOU Pei2,LI Qi-heng2,ZHANG Jie2,CUI Jia2,CUI Hui-ping2,LIU Li2,WANG Shou-li1,2* |
(1. The Fifth Clinical Medical College, No. 306 Clinical College of PLA, Anhui Medical University, Beijing 100101, China;
2. Department of Cardiovasology, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the correlation between plasma interleukin (IL)-22 level and the severity of coronary artery disease and 5-year prognosis in patients with acute myocardial infarction (AMI). Methods A total of 98 AMI patients who underwent emergency percutaneous coronary intervention in Special Medical Center of Strategic Support Force from Oct. 2014 to Dec. 2016 were selected, including 58 cases of ST segment elevation myocardial infarction (STEMI) and 40 cases of non-ST segment elevation myocardial infarction (NSTEMI). Forty patients with normal coronary angiography during the same period were selected for control group. The plasma levels of inflammatory cytokines IL-22, IL-1β, IL-6 and tumor necrosis factor α (TNF-α) were measured by Luminex liquid chip technique. The baseline data and plasma levels of inflammatory cytokines were compared among the 3 groups to analyze the relationship between IL-22 level and other inflammatory cytokines in AMI patients. Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between plasma IL-22 level and SYNergy between percutaneous coronary intervention with TAXUSTM and cardiac surgery (SYNTAX) score. Receiver operating characteristic (ROC) curve was used to analyze the prediction ability of some indexes (such as IL-22) for medium-high SYNTAX scores. Binary logistic regression analysis was used to analyze the risk factors of major adverse cardiovascular and cerebrovascular event (MACCE) in patients with AMI within 5 years after discharge. Results There were no significant differences in baseline data such as age, gender or smoking history between the AMI group and control group (all P>0.05). The proportions of patients with family history of coronary heart disease, fasting blood glucose, hypersensitive C reactive protein and brain natriuretic peptide in the STEMI and NSTEMI groups were higher than those in the control group (all P<0.05), while the levels of high density lipoprotein-cholesterol and left ventricular ejection fraction (LVEF) were lower than those in the control group (both P<0.05). The plasma levels of IL-22, IL-1β, IL-6 and TNF-α in AMI patients were significantly higher than those in the control group (all P< 0.05). Plasma IL-22 level was positively correlated with IL-1β (r=0.793, P=0.001), IL-6 (r=0.880, P<0.001) and TNF-α (r=0.840, P<0.001). SYNTAX score was positively correlated with IL-22 (r=0.478, P=0.001), IL-6 (r=0.242, P=0.017), age (r=0.217, P=0.032) and cardiac troponin I (r=0.261, P=0.010), and negatively correlated with LVEF (r=-0.224, P=0.034). Multiple linear regression analysis with SYNTAX score used as dependent variable, IL-22 (β=0.269, P=0.023), age (β=0.236, P=0.016) and LVEF (β=-0.235, P=0.023) were the influence factors of SYNTAX score. The analysis of ROC curve showed that the predictive ability of plasma IL-22 for medium-high SYNTAX scores (area under curve[AUC]=0.760, 95% confidence interval[CI] 0.656-0.863, P=0.001) was higher than that of age (AUC=0.612, 95% CI 0.478-0.746, P=0.112) and LVEF (AUC=0.628, 95% CI 0.485-0.770, P=0.070). There was no correlation between SYNTAX score and plasma IL-22 level and MACCE in patients with AMI within 5 years after discharge. Conclusion Plasma IL-22 level is related to AMI and can reflect the severity of coronary artery disease. It has good predictive value for judging the condition of patients with AMI, but the correlation with the prognosis of patients needs to be further verified. |
| Key words: acute myocardial infarction interleukin 22 coronary artery disease SYNTAX score major adverse cardiovascular and cerebrovascular events |
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