Tan Jing, Hua Qi, Li Jing, Fan Zhenxing
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.
Heart Vessels. 2009 Sep;24(5):329-34. doi: 10.1007/s00380-008-1128-8. Epub 2009 Sep 27.
Accumulating evidence suggests that inflammation plays an essential role in the pathogenesis of atherosclerosis. This recognition has stimulated the evaluation of different inflammatory markers as potential predictors of cardiovascular risk. However, the existing data are limited and controversial. This study was designed to simultaneously measure serum levels of interleukin-6 (IL-6), soluble CD40 ligand (sCD40L), metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in patients with acute ST segment elevation myocardial infarction (STEMI) and to evaluate their ability to predict prognosis. A prospective cohort study was conducted with 263 patients with first STEMI who were admitted to our institute within 6 h of symptoms onset. Clinical data were recorded and serum admission levels of IL-6, sCD40L, MMP-9, and TIMP-1 were measured by sandwich enzyme-linked immunosorbent assay. The patients were then followed prospectively for the occurrence of cardiovascular mortality for 3 years. Follow-up information was available for 228 patients (86.7%) from the 263 STEMI patients; 34 patients died from cardiovascular causes during the 3-year follow-up period. Kaplan-Meier plots demonstrated a significant increase in cardiovascular mortality with increasing IL-6 levels (chi(2) = 14.13, P = 0.0002, by log-rank test). Logistic regression analysis revealed that IL-6 was an independent predictor for cardiovascular mortality. The present study indicates that elevated admission level of IL-6 could provide valuable information for long-term risk stratification in patients with STEMI.
越来越多的证据表明，炎症在动脉粥样硬化的发病机制中起着至关重要的作用。这一认识促使人们对不同的炎症标志物作为心血管风险潜在预测指标进行评估。然而，现有数据有限且存在争议。本研究旨在同时测定急性ST段抬高型心肌梗死（STEMI）患者血清白细胞介素-6（IL-6）、可溶性CD40配体（sCD40L）、金属蛋白酶-9（MMP-9）和金属蛋白酶组织抑制剂-1（TIMP-1）的水平，并评估它们预测预后的能力。对263例首发STEMI患者进行了一项前瞻性队列研究，这些患者在症状发作后6小时内入院。记录临床数据，并采用夹心酶联免疫吸附测定法测定入院时血清中IL-6、sCD40L、MMP-9和TIMP-1的水平。然后对患者进行为期3年的前瞻性随访，观察心血管死亡的发生情况。263例STEMI患者中有228例（86.7%）获得了随访信息；34例患者在3年随访期内因心血管原因死亡。Kaplan-Meier曲线显示，随着IL-6水平升高，心血管死亡率显著增加（对数秩检验，χ(2)=14.13，P = 0.0002）。逻辑回归分析显示，IL-6是心血管死亡的独立预测因素。本研究表明，STEMI患者入院时IL-6水平升高可为长期风险分层提供有价值的信息。
