3rd Department of Cardiology, Silesian Center for Heart Disease, Silesian Medical University, Zabrze, Poland.
J Biol Regul Homeost Agents. 2010 Apr-Jun;24(2):149-56.
Percutaneous coronary intervention (PCI) has revolutionized the management of and outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The role of insulin-like growth factor-I (IGF-I) and tumor necrosis factor-alpha (TNF-alpha) in restenosis has been intensively studied. We aimed to investigate the power of serum IGF-I and TNF-alpha concentrations to predict restenosis in patients who had previously undergone PCI for STEMI. Thirty-seven patients were enrolled in the study. Twelve months prior to the study they underwent successful PCI with stent placement for STEMI. The patients were divided into two groups: group 1 - patients with in-stent restenosis in the infarct-related artery (N=9); group 2 - patients without in-stent restenosis in the infarct-related artery (N=28). Baseline profile was similar in both groups. The mean diameter and length of placed stents were similar in both groups. Smaller minimal lumen diameter (MLD) and greater lumen loss (LL) were observed in group 1. Median IGF-I concentrations were substantially higher in patients with ISR compared to those without ISR (170 ng/mL vs 115 ng/mL, p=0.004). Strikingly, median TNF-alpha levels were lower in group 1 (2.4 pg/mL vs 4.1 pg/mL, p=0.05). Correlation analysis showed that serum IGF-I levels were significantly associated with diameter stenosis (R=0.29 p=0.05), LL (R=0.37 p=0.02), MLD (R= -0.38 p=0.03), and stent length (R=0.30 p=0.05). The cut-off value to predict restenosis for IGF-I was less than 158 ng/mL (sensitivity 55 percent, specificity 93 percent, positive predictive value 71 percent, negative predictive value 87 percent). IGF-I detected twelve months after stent placement during the acute phase of AMI may be a late determinant of restenosis. High concentrations of IGF-I could play a permissive role in the progression of NIH and subsequently restenosis. It seems that as far as TNF-alpha is concerned, diagnostic value remains inconclusive.
经皮冠状动脉介入治疗（PCI）彻底改变了 ST 段抬高型心肌梗死（STEMI）患者的治疗效果和预后。胰岛素样生长因子-I（IGF-I）和肿瘤坏死因子-α（TNF-α）在再狭窄中的作用已得到深入研究。我们旨在研究血清 IGF-I 和 TNF-α浓度预测 STEMI 患者 PCI 后再狭窄的能力。
研究纳入 37 名患者。在研究前 12 个月，他们因 STEMI 接受了成功的 PCI 支架置入术。患者分为两组：组 1 - 梗死相关动脉内支架内再狭窄患者（N=9）；组 2 - 梗死相关动脉内无支架内再狭窄患者（N=28）。两组基线特征相似。两组置入支架的平均直径和长度相似。组 1 观察到较小的最小管腔直径（MLD）和较大的管腔丢失（LL）。与无 ISR 患者相比，ISR 患者的 IGF-I 浓度中位数明显更高（170ng/ml 比 115ng/ml，p=0.004）。引人注目的是，组 1 的 TNF-α水平显著较低（2.4pg/ml 比 4.1pg/ml，p=0.05）。
相关性分析表明，血清 IGF-I 水平与直径狭窄（R=0.29，p=0.05）、LL（R=0.37，p=0.02）、MLD（R= -0.38，p=0.03）和支架长度（R=0.30，p=0.05）显著相关。IGF-I 预测再狭窄的截断值小于 158ng/ml（灵敏度 55%，特异性 93%，阳性预测值 71%，阴性预测值 87%）。
AMI 急性期支架置入 12 个月后检测到的 IGF-I 可能是再狭窄的晚期决定因素。高浓度的 IGF-I 可能在 NIH 的进展中发挥允许作用，随后导致再狭窄。就 TNF-α而言，其诊断价值仍不确定。
