Espinola-Klein Christine, Rupprecht Hans J, Bickel Christoph, Lackner Karl, Genth-Zotz Sabine, Post Felix, Munzel Thomas, Blankenberg Stefan
Medical Department II, Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz, Germany.
Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):278-84. doi: 10.1097/HJR.0b013e3282f37a6e.
Recent investigations suggest the inclusion of inflammatory markers in the definition of the metabolic syndrome (MS). The aim of this study was to address the role of C-reactive protein, fibrinogen, interleukin-6 (IL-6) and IL-18 (IL-18) on cardiovascular prognosis in accordance to MS.
A total of 1263 patients with documented coronary artery disease were prospectively included. We defined MS (MS yes: N=533, 42.2%) as the presence of at least three of the following criteria: triglycerides>or=150 mg/dl; low high-density lipoprotein cholesterol (men: <40 mg/dl women: <50 mg/dl); body mass index greater than 30 kg/m; blood pressure>or=130/85 mmHg; fasting glucose>or=100 mg/dl. In addition, we determined C-reactive protein, fibrinogen, IL-6 and IL-18 levels.
Follow-up data (median 6.1 years) were available for 1257 patients (99.5%). 139 patients (11.1%) died from cardiovascular causes. Cardiovascular mortality was related to MS (MS yes: 15.1% versus MS no: 8.1%, P<0.0001) and was further increased by elevation of each inflammatory marker. To address whether elevation of inflammatory markers provides additional prognostic information, a subgroup analysis was performed including patients with MS. In a multivariate-adjusted model including all four inflammatory markers, only IL-18 could be identified as an independent predictor of cardiovascular mortality.
The measurement of inflammatory markers, especially IL-18, adds important prognostic information with regard to the long-term prognosis of patients with MS.
近期研究表明，代谢综合征（MS）的定义中应纳入炎症标志物。本研究旨在探讨C反应蛋白、纤维蛋白原、白细胞介素-6（IL-6）和白细胞介素-18（IL-18）在MS患者心血管预后中的作用。
前瞻性纳入1263例有冠状动脉疾病记录的患者。我们将MS（MS阳性：N = 533，42.2%）定义为存在以下至少三项标准：甘油三酯≥150mg/dl；低高密度脂蛋白胆固醇（男性：<40mg/dl，女性：<50mg/dl）；体重指数大于30kg/m²；血压≥130/85mmHg；空腹血糖≥100mg/dl。此外，我们测定了C反应蛋白、纤维蛋白原、IL-6和IL-18水平。
1257例患者（99.5%）有随访数据（中位随访时间6.1年）。139例患者（11.1%）死于心血管原因。心血管死亡率与MS相关（MS阳性：15.1%，MS阴性：8.1%，P<0.0001），且每种炎症标志物升高会进一步增加心血管死亡率。为探讨炎症标志物升高是否提供额外的预后信息，对MS患者进行了亚组分析。在包含所有四种炎症标志物的多变量调整模型中，只有IL-18可被确定为心血管死亡率的独立预测因子。
炎症标志物的检测，尤其是IL-18，为MS患者的长期预后提供了重要的预后信息。
