Nishii Mototsugu, Inomata Takayuki, Takehana Hitoshi, Takeuchi Ichiro, Nakano Hironari, Koitabashi Toshimi, Nakahata Jun-ichi, Aoyama Naoyoshi, Izumi Tohru
Department of Internal Medicine and Cardiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
J Am Coll Cardiol. 2004 Sep 15;44(6):1292-7. doi: 10.1016/j.jacc.2004.01.055.
We assessed the significance of serum cytokine levels in patients with fulminant myocarditis.
Although many investigations have demonstrated the crucial role of cytokines in the development of myocarditis, it remains uncertain whether serum levels of cytokines enable one to predict the prognosis of human myocarditis, especially concerning cardiogenic shock (CS) requiring a mechanical cardiopulmonary support system (MCSS).
We studied 22 consecutive patients with fulminant myocarditis and compared them with 15 patients with acute myocardial infarction (AMI) requiring MCSS. The patients with myocarditis were classified into three groups: eight patients with CS requiring MCSS on admission (group 1); six patients who unexpectedly lapsed into CS requiring MCSS more than two days after catecholamine had been initiated (group 2); and eight patients without MCSS (group 3). Furthermore, 14 patients with myocarditis requiring MCSS were divided into a fatal group (n = 5) and a survival group (n = 9). Biochemical markers, including serum cytokine levels and hemodynamic variables on admission, were analyzed.
Serum levels of interleukin (IL)-10 and tumor necrosis factor-alpha, but not other cytokines, were significantly higher in myocarditis than in AMI. Only serum levels of IL-10 were significantly higher in group 1 and 2 than in group 3 (49.1 +/- 37.5/20.7 +/- 17.6 pg/ml vs. 2.4 +/- 1.1 pg/ml; p = 0.0008/0.0012). Serum IL-10 levels were also significantly higher in the fatal group than in the survival group with myocarditis (74.0 +/- 27.0 pg/ml vs. 16.4 +/- 8.8 pg/ml; p = 0.003).
Serum IL-10 levels on admission enabled one to predict subsequent CS requiring MCSS and mortality of fulminant myocarditis patients.
我们评估了暴发性心肌炎患者血清细胞因子水平的意义。
尽管许多研究已证明细胞因子在心肌炎发展过程中起关键作用，但血清细胞因子水平能否用于预测人类心肌炎的预后，尤其是对于需要机械心肺支持系统（MCSS）的心源性休克（CS），仍不确定。
我们研究了22例连续的暴发性心肌炎患者，并将他们与15例需要MCSS的急性心肌梗死（AMI）患者进行比较。心肌炎患者分为三组：8例入院时需要MCSS的CS患者（第1组）；6例在开始使用儿茶酚胺后两天以上意外陷入需要MCSS的CS患者（第2组）；8例未使用MCSS的患者（第3组）。此外，14例需要MCSS的心肌炎患者分为死亡组（n = 5）和存活组（n = 9）。分析了入院时的生化指标，包括血清细胞因子水平和血流动力学变量。
心肌炎患者血清白细胞介素（IL）-10和肿瘤坏死因子-α水平显著高于AMI患者，而其他细胞因子则不然。仅第1组和第2组的血清IL-10水平显著高于第3组（49.1±37.5/20.7±17.6 pg/ml对2.4±1.1 pg/ml；p = 0.0008/0.0012）。心肌炎死亡组的血清IL-10水平也显著高于存活组（74.0±27.0 pg/ml对16.4±8.8 pg/ml；p = 0.003）。
入院时的血清IL-10水平能够预测暴发性心肌炎患者随后需要MCSS的心源性休克及死亡率。
