Patti Giuseppe, Mega Simona, Pasceri Vincenzo, Nusca Annunziata, Giorgi Gabriele, Zardi Enrico Maria, D'Ambrosio Andrea, Dobrina Aldo, Di Sciascio Germano
Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
Clin Cardiol. 2005 Apr;28(4):193-6. doi: 10.1002/clc.4960280409.
Interleukin-1 receptor antagonist (IL-1Ra) levels are elevated early in patients with acute myocardial infarction (MI) and often precede release of markers of necrosis; however, IL-1Ra levels did not correlate previously with infarct size and prognosis in such patients.
The goal of our study was to evaluate prospectively the correlation between IL-1Ra levels upon emergency department (ED) presentation and the extent of myocardial necrosis and prognosis in patients with ST-segment elevation MI.
Levels of IL-1Ra were measured upon ED presentation in 44 consecutive patients (40 men, aged 55 +/- 10 years). Peak values of creatine kinase (CK) and CK-MB were determined during hospitalization, and left ventricular ejection fraction (LVEF) was evaluated by echocardiography before discharge. All patients were followed prospectively and underwent clinical and echocardiographic assessment at 42 +/- 3 months after the infarction.
Levels of IL-1Ra upon ED presentation correlated directly with CK (p = 0.002) and CK-MB (p = 0.01) peak levels and correlated inversely with LVEF before discharge (p = 0.009). Patients with in-hospital adverse events had significantly higher IL-1Ra levels upon ED admission (n = 10,2620 +/- 4706 pg/ml) than those without events (n = 34,598 +/- 457 pg/ml) (p = 0.015).
In patients with MI, levels of IL-1Ra upon ED presentation correlated significantly with the extent of myocardial necrosis, as measured by cardiac enzymes peak and reduction of LVEF, and are predictive of in-hospital events. Results of this study may influence early therapeutic approach in patients with acute MI.
急性心肌梗死（MI）患者早期白细胞介素-1受体拮抗剂（IL-1Ra）水平升高，且常先于坏死标志物的释放；然而，此前此类患者的IL-1Ra水平与梗死面积及预后并无关联。
我们研究的目的是前瞻性评估急诊科（ED）就诊时IL-1Ra水平与ST段抬高型心肌梗死患者心肌坏死程度及预后之间的相关性。
对44例连续患者（40例男性，年龄55±10岁）在ED就诊时测定IL-1Ra水平。住院期间测定肌酸激酶（CK）和CK-MB的峰值，出院前通过超声心动图评估左心室射血分数（LVEF）。对所有患者进行前瞻性随访，并在心肌梗死后42±3个月进行临床和超声心动图评估。
ED就诊时IL-1Ra水平与CK（p = 0.002）和CK-MB（p = 0.01）的峰值水平呈正相关，与出院前LVEF呈负相关（p = 0.009）。住院期间发生不良事件的患者在ED入院时的IL-1Ra水平（n = 10，2620±4706 pg/ml）显著高于未发生事件的患者（n = 34，598±457 pg/ml）（p = 0.015）。
在心肌梗死患者中，ED就诊时IL-1Ra水平与心肌坏死程度显著相关，心肌坏死程度通过心肌酶峰值和LVEF降低来衡量，且可预测住院期间的事件。本研究结果可能会影响急性心肌梗死患者的早期治疗方法。
