高水平的促炎因子白细胞介素-17 和白细胞介素-23 与心脏骤停患者的不良预后相关：一项单中心经验。
High plasma levels of pro-inflammatory factors interleukin-17 and interleukin-23 are associated with poor outcome of cardiac-arrest patients: a single center experience.
机构信息
Department of Emergency Medicine, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Key Laboratory of Molecular Pharmacology and Drug Evaluation (Yantai University), Ministry of Education, Yantai University, Yantai, China.
出版信息
BMC Cardiovasc Disord. 2020 Apr 15;20(1):170. doi: 10.1186/s12872-020-01451-y.
BACKGROUND
Systemic inflammation is an important feature of post-cardiac arrest syndrome (PCAS). This study was designed to determine whether the plasma concentrations of some circulating pro-inflammatory cytokines (interleukin-17 [IL-8], IL-22, IL-23 and IL-33) are of value in predicting the outcome of patients after return of spontaneous circulation (ROSC) during the post-cardiac arrest period.
METHODS
This was a prospective observational clinical study. In total, 21 patients (survivors, n = 10; non-survivors, n = 11) who experienced cardiac arrest and successful ROSC with expected survival of at least 7 days were consecutively enrolled from January 2016 to December 2017. Of the 21 enrolled patients, ten survived were designated "survivors". The other eleven patients died between 2 days and 1 months post ROSC. Venous blood was drawn at three time-points: baseline (< 1 h post ROSC), 2 days post ROSC and 7 days post ROSC. Plasma IL-8, IL-22, IL-23 and IL-33 were determined using commercial enzyme-linked immunosorbent assays.
RESULTS
Plasma creatinine levels, but aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, were elevated in non-survivors compared with survivors. Plasma levels of IL-17, IL-22, IL-23 and IL-33 of the 21 total patients did not change at 2 or 7 days post ROSC compared to baseline. In survivors, the plasma levels of IL-17 and IL-23 at 2 or 7 days post ROSC were lower than baseline. In non-survivors, plasma levels of IL-17 increased compared with baseline. Receiver operating characteristic curve analysis showed that the plasma levels of IL-17 and IL-23 at 2 or 7 days post ROSC were able to predict the mortality of PCAS patients, and positively correlated with Acute Physiology and Chronic Health Evaluation (APACHE)-II score and time to ROSC.
CONCLUSION
These results provide the first evidence that the elevated plasma IL-17 and IL-23 levels are associated with poor outcome in PCAS patients. The role of IL-17/IL-23 axis post ROSC is worth paying attention to in PCAS patients.
TRIAL REGISTRATION
Clinicaltrial.govNCT02297776, 2014-11-21.
背景
全身炎症是心搏骤停后综合征（PCAS）的一个重要特征。本研究旨在确定循环中一些促炎细胞因子（白细胞介素 17 [IL-17]、IL-22、IL-23 和 IL-33）的血浆浓度是否可用于预测心搏骤停后复苏期间患者的预后。
方法
这是一项前瞻性观察性临床研究。2016 年 1 月至 2017 年 12 月，连续纳入 21 例心搏骤停并成功复苏且预计至少存活 7 天的患者（幸存者，n=10；非幸存者，n=11）。在纳入的 21 例患者中，有 10 例存活者被指定为“幸存者”。其余 11 例患者在 ROSC 后 2 天至 1 个月内死亡。在三个时间点采集静脉血：基线（ROSC 后<1 小时）、ROSC 后 2 天和 ROCS 后 7 天。使用商业酶联免疫吸附试验测定血浆 IL-8、IL-22、IL-23 和 IL-33。
结果
与幸存者相比，非幸存者的血浆肌酐水平升高，但天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平升高。与基线相比，21 例患者的 IL-17、IL-22、IL-23 和 IL-33 血浆水平在 ROCS 后 2 天或 7 天没有变化。在幸存者中，ROSC 后 2 天或 7 天的 IL-17 和 IL-23 血浆水平低于基线。在非幸存者中，IL-17 血浆水平与基线相比升高。受试者工作特征曲线分析表明，ROSC 后 2 天或 7 天的 IL-17 和 IL-23 血浆水平能够预测 PCAS 患者的死亡率，并与急性生理学和慢性健康评估（APACHE）-II 评分和 ROSC 时间呈正相关。
结论
这些结果首次提供了证据表明，升高的血浆 IL-17 和 IL-23 水平与 PCAS 患者不良预后相关。ROSC 后 IL-17/IL-23 轴的作用值得在 PCAS 患者中引起关注。
试验注册
Clinicaltrial.govNCT02297776，2014 年 11 月 21 日。
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