Heeschen Christopher, Dimmeler Stefanie, Hamm Christian W, Fichtlscherer Stephan, Boersma Eric, Simoons Maarten L, Zeiher Andreas M
Department of Internal Medicine IV, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Circulation. 2003 Apr 29;107(16):2109-14. doi: 10.1161/01.CIR.0000065232.57371.25. Epub 2003 Mar 31.
Convincing evidence suggests that atherosclerosis is an inflammatory disease. The inflammatory response is an important determinant of atherosclerotic plaque instability. Therefore, we investigated the prognostic impact of key inflammatory players, namely the inflammatory marker C-reactive protein (CRP) and the antiinflammatory cytokine interleukin-10 (IL-10), in patients with acute coronary syndromes.
IL-10, CRP, and troponin T were measured at baseline and before discharge in 547 patients enrolled in the placebo group of the c7E3 Anti Platelet Therapy in Unstable Refractory angina (CAPTURE) trial. Death and nonfatal myocardial infarction were recorded during 6-month follow-up. IL-10 levels did not correlate with troponin T concentrations but were inversely correlated with CRP levels (P<0.001). Patients with elevated IL-10 levels (>3.5 pg/mL; n=276) were at significantly lower risk compared with patients with elevated IL-10 levels (hazard ratio, 0.33; 95% confidence interval [CI], 0.25 to 0.76; P=0.002). The predictive value of IL-10 was independent of myocardial necrosis but significantly interacted with CRP levels. CRP-positive patients with IL-10 serum levels above the calculated threshold value of 3.5 pg/mL were protected from the increased cardiac risk of CRP-positive patients with low IL-10 levels (adjusted hazard ratio, 0.25; 95% CI, 0.10 to 0.63; P=0.003). Moreover, discharge IL-10 levels >2.5 pg/mL were associated with lower cardiac risk during 6-month follow-up (hazard ratio, 0.38; 95% CI, 0.19 to 0.83; P=0.005).
Elevated IL-10 serum levels are associated with a more favorable prognosis in patients with acute coronary syndromes and elevated CRP levels. These data demonstrate the importance of the balance between proinflammatory and antiinflammatory markers as a major determinant of patients' outcome in acute coronary syndromes.
有确凿证据表明动脉粥样硬化是一种炎症性疾病。炎症反应是动脉粥样硬化斑块不稳定性的重要决定因素。因此，我们研究了关键炎症因子，即炎症标志物C反应蛋白（CRP）和抗炎细胞因子白细胞介素-10（IL-10）对急性冠状动脉综合征患者的预后影响。
在不稳定难治性心绞痛的c7E3抗血小板治疗（CAPTURE）试验的安慰剂组纳入的547例患者中，于基线和出院前测量IL-10、CRP和肌钙蛋白T。在6个月的随访期间记录死亡和非致命性心肌梗死情况。IL-10水平与肌钙蛋白T浓度无相关性，但与CRP水平呈负相关（P<0.001）。IL-10水平升高（>3.5 pg/mL；n=276）的患者与IL-10水平未升高的患者相比，风险显著更低（风险比，0.33；95%置信区间[CI]，0.25至0.76；P=0.002）。IL-10的预测价值独立于心肌坏死，但与CRP水平有显著交互作用。IL-10血清水平高于计算阈值3.5 pg/mL的CRP阳性患者，可免受IL-10水平低的CRP阳性患者心脏风险增加的影响（校正风险比，0.25；95%CI，0.10至0.63；P=0.003）。此外，出院时IL-10水平>2.5 pg/mL与6个月随访期间较低的心脏风险相关（风险比，0.38；95%CI，0.19至0.83；P=0.005）。
IL-10血清水平升高与急性冠状动脉综合征且CRP水平升高的患者预后更有利相关。这些数据表明促炎和抗炎标志物之间的平衡作为急性冠状动脉综合征患者预后的主要决定因素的重要性。
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