血浆白细胞介素-6 与 ST 段抬高型心肌梗死的梗死面积、再灌注损伤和不良重构的关系。
Association of plasma interleukin-6 with infarct size, reperfusion injury, and adverse remodelling after ST-elevation myocardial infarction.
机构信息
Departement of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck A-6020, Austria.
Department of Internal Medicine, Academic Teaching Hospital Hall in Tirol, Milserstrasse 10, Hall in Tirol A-6060, Austria.
出版信息
Eur Heart J Acute Cardiovasc Care. 2022 Feb 8;11(2):113-123. doi: 10.1093/ehjacc/zuab110.
AIMS
Little is known about the clinical relevance of interleukin (IL)-6 in patients with acute ST-elevation myocardial infarction (STEMI). This study examined the possible associations of plasma IL-6 concentrations with infarct size (IS), reperfusion injury and adverse left ventricular remodelling (LVR), in STEMI patients treated with primary percutaneous coronary intervention (PCI).
METHODS AND RESULTS
We prospectively included 170 consecutive STEMI patients (median age 57 years, 14% women) treated with primary PCI between 2017 and 2019. Blood samples for biomarker analyses including IL-6 were collected on Day 2. Left ventricular ejection fraction (LVEF), IS, and reperfusion injury [microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)] were determined using cardiac magnetic resonance (CMR) imaging on Day 4. Left ventricular remodelling was defined as ≥10% increase in left ventricular end-diastolic volume from baseline to 4 months CMR follow-up. Patients with IL-6 concentrations ≥median (17 ng/L) showed a significantly lower LVEF (43% vs. 52%, P < 0.001), larger IS (22% vs. 13%, P < 0.001), larger MVO (1.9% vs. 0.0%, P < 0.001), and more frequent IMH (52% vs. 18%, P < 0.001). Left ventricular remodelling was more common in patients with IL-6 ≥ median (24% vs. 9%, P = 0.005). In both linear and binary multivariable regression analyses, IL-6 remained independently associated with lower LVEF [odds ratio (OR): 0.10, 95% confidence interval (CI) 0.02-0.42, P = 0.002], larger IS (OR: 5.29, 95% CI 1.52-18.40, P = 0.009), larger MVO (OR: 5.20, 95% CI 1.30-20.85, P = 0.020), with presence of IMH (OR: 3.73, 95% CI 1.27-10.99, P = 0.017), and adverse LVR (OR: 2.72, 95% 1.06-6.98, P = 0.038).
CONCLUSIONS
High concentrations of circulating plasma IL-6 on Day 2 after STEMI were independently associated with worse myocardial function, larger infarct extent, more severe reperfusion injury, and a higher likelihood for LVR, suggesting IL-6 as a useful biomarker of more serious outcome and potential therapeutic target.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT04113356;NCT04113356.
目的
目前对于白细胞介素（IL）-6 在急性 ST 段抬高型心肌梗死（STEMI）患者中的临床相关性知之甚少。本研究旨在探讨 STEMI 患者接受直接经皮冠状动脉介入治疗（PCI）后，血浆 IL-6 浓度与梗死面积（IS）、再灌注损伤和不良左心室重构（LVR）之间的可能相关性。
方法和结果
我们前瞻性纳入了 2017 年至 2019 年间接受直接 PCI 治疗的 170 例连续 STEMI 患者（中位年龄 57 岁，14%为女性）。在第 2 天采集用于生物标志物分析的血液样本，包括 IL-6。在第 4 天使用心脏磁共振（CMR）成像确定左心室射血分数（LVEF）、IS 和再灌注损伤[微血管阻塞（MVO）和心肌内出血（IMH）]。左心室重构定义为与基线相比，4 个月 CMR 随访时左心室舒张末期容积增加≥10%。IL-6 浓度≥中位数（17ng/L）的患者 LVEF 显著降低（43% vs. 52%，P<0.001）、IS 更大（22% vs. 13%，P<0.001）、MVO 更多（1.9% vs. 0.0%，P<0.001）、IMH 更常见（52% vs. 18%，P<0.001）。IL-6≥中位数的患者左心室重构更常见（24% vs. 9%，P=0.005）。在线性和二元多变量回归分析中，IL-6 与较低的 LVEF[比值比（OR）：0.10，95%置信区间（CI）0.02-0.42，P=0.002]、更大的 IS（OR：5.29，95%CI 1.52-18.40，P=0.009）、更大的 MVO（OR：5.20，95%CI 1.30-20.85，P=0.020）、IMH 存在（OR：3.73，95%CI 1.27-10.99，P=0.017）和不良 LVR（OR：2.72，95%CI 1.06-6.98，P=0.038）独立相关。
结论
STEMI 后第 2 天循环血浆 IL-6 浓度较高与心肌功能更差、梗死面积更大、再灌注损伤更严重以及 LVR 可能性更高独立相关，提示 IL-6 可作为更严重结局和潜在治疗靶点的有用生物标志物。
临床试验注册
https://clinicaltrials.gov/ct2/show/NCT04113356；NCT04113356。
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