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白细胞介素-8 与 STEMI 患者梗死面积和临床结局的关系。

Association of IL-8 With Infarct Size and Clinical Outcomes in Patients With STEMI.

机构信息

Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; Center for Clinical Heart Research, Oslo University Hospital Ullevål, Oslo, Norway; Center for Heart Failure Research, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.

Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway; National Association for Heart and Lung Diseases Clinics, Feiring Heart Clinic, Feiring, Norway.

出版信息

J Am Coll Cardiol. 2018 Jul 10;72(2):187-198. doi: 10.1016/j.jacc.2018.04.053.

Abstract

BACKGROUND

Little is known about the role of interleukin (IL)-8 in patients with acute ST-segment elevation myocardial infarction (STEMI).

OBJECTIVES

The aims of this study were to evaluate, in STEMI patients, the temporal profile of IL-8 and possible associations with left ventricular (LV) function and remodeling, infarct size, microvascular obstruction, myocardial salvage, and future clinical events.

METHODS

A total of 258 patients with STEMI were included. Blood samples were drawn before and immediately after percutaneous coronary intervention (PCI), at day 1, and after 4 months. Cardiac magnetic resonance imaging was performed in the acute phase and after 4 months. Clinical events were registered during 12 months' follow-up and all-cause mortality after median 70 months' follow-up.

RESULTS

Patients with IL-8 levels greater than the median measured both immediately after PCI and at day 1 had larger final infarct size, lower LV ejection fraction, larger increase in LV end-diastolic volume, and higher frequency of microvascular obstruction. After multivariate adjustment, high IL-8 levels at day 1 were associated with an increased risk of developing a large MI and having reduced LV ejection fraction at 4 months, also after adjustment for peak troponin value. Patients with IL-8 levels in the highest quartile measured at all sampling points were more likely to have a clinical event during the first 12 months after the MI and had lower overall survival during long-term follow-up.

CONCLUSIONS

High levels of circulating IL-8 were associated with large infarct size, impaired recovery of LV function, and adverse clinical outcome in patients with STEMI, suggesting IL-8 as a future therapeutic target based on its important role in post-infarction inflammation.

摘要

背景

关于白细胞介素(IL)-8 在急性 ST 段抬高型心肌梗死(STEMI)患者中的作用知之甚少。

目的

本研究旨在评估 STEMI 患者中 IL-8 的时间变化特征及其与左心室(LV)功能和重构、梗死面积、微血管阻塞、心肌挽救和未来临床事件的可能相关性。

方法

共纳入 258 例 STEMI 患者。在经皮冠状动脉介入治疗(PCI)前、即刻、第 1 天和 4 个月时采集血液样本。在急性期和 4 个月时进行心脏磁共振成像。在 12 个月的随访期间记录临床事件,并在中位 70 个月的随访后记录全因死亡率。

结果

IL-8 水平高于即刻和第 1 天中位数的患者最终梗死面积较大,LV 射血分数较低,LV 舒张末期容积增加较大,微血管阻塞发生率较高。经多变量调整后,第 1 天的高 IL-8 水平与发生大 MI 和 4 个月时 LV 射血分数降低的风险增加相关,即使在调整了峰值肌钙蛋白值后也是如此。在所有采样点测量的 IL-8 水平处于最高四分位数的患者在 MI 后 12 个月内更有可能发生临床事件,并且在长期随访中总生存率较低。

结论

循环 IL-8 水平升高与 STEMI 患者的大面积梗死、LV 功能恢复受损和不良临床结局相关,表明 IL-8 作为一种新的治疗靶点,基于其在梗死后炎症中的重要作用。

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