轻度低温治疗急性心肌梗死并发心源性休克患者循环单核细胞趋化蛋白-1：SHOCK-COOL试验的生物标志物子研究
Circulating Monocyte Chemoattractant Protein-1 in Patients with Cardiogenic Shock Complicating Acute Myocardial Infarction Treated with Mild Hypothermia: A Biomarker Substudy of SHOCK-COOL Trial.
作者信息
Cheng Wenke, Fuernau Georg, Desch Steffen, Freund Anne, Feistritzer Hans-Josef, Pöss Janine, Buettner Petra, Thiele Holger
机构信息
Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany.
Medical Faculty, University of Leipzig, 04103 Leipzig, Germany.
出版信息
J Cardiovasc Dev Dis. 2022 Aug 20;9(8):280. doi: 10.3390/jcdd9080280.
BACKGROUND
There is evidence that monocyte chemoattractant protein-1 (MCP-1) levels reflect the intensity of the inflammatory response in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) and have a predictive value for clinical outcomes. However, little is known about the effect of mild therapeutic hypothermia (MTH) on the inflammatory response in patients with CS complicating AMI. Therefore, we conducted a biomarker study to investigate the effect of MTH on MCP-1 levels in patients with CS complicating AMI.
METHODS
In the randomized mild hypothermia in cardiogenic shock (SHOCK-COOL) trial, 40 patients with CS complicating AMI were enrolled and assigned to MTH (33 °C) for 24 h or normothermia at a 1:1 ratio. Blood samples were collected at predefined time points at the day of admission/day 1, day 2 and day 3. Differences in MCP-1 levels between and within the MTH and normothermia groups were assessed. Additionally, the association of MCP-1 levels with the risk of all-cause mortality at 30 days was analyzed. Missing data were accounted for by multiple imputation as sensitivity analyses.
RESULTS
There were differences in MCP-1 levels over time between patients in MTH and normothermia groups ( for interaction = 0.013). MCP-1 levels on day 3 were higher than on day 1 in the MTH group (day 1 vs day 3: 21.2 [interquartile range, 0.25-79.9] vs. 125.7 [interquartile range, 87.3-165.4] pg/mL; = 0.006) and higher than in the normothermia group at day 3 (MTH 125.7 [interquartile range, 87.3-165.4] vs. normothermia 12.3 [interquartile range, 0-63.9] pg/mL; 0.011). Irrespective of therapy, patients with higher levels of MCP-1 at hospitalization tended to have a decreased risk of all-cause mortality at 30 days (HR, 2.61; 95% CI 0.997-6.83; = 0.051).
CONCLUSIONS
The cooling phase of MTH had no significant effect on MCP-1 levels in patients with CS complicating AMI compared to normothermic control, whereas MCP-1 levels significantly increased after rewarming.
TRIAL REGISTRATION
NCT01890317.
背景
有证据表明，单核细胞趋化蛋白-1（MCP-1）水平反映了并发急性心肌梗死（AMI）的心源性休克（CS）患者炎症反应的强度，并且对临床结局具有预测价值。然而，关于轻度治疗性低温（MTH）对并发AMI的CS患者炎症反应的影响知之甚少。因此，我们开展了一项生物标志物研究，以调查MTH对并发AMI的CS患者MCP-1水平的影响。
方法
在“心源性休克低温治疗（SHOCK-COOL）”试验中，纳入40例并发AMI的CS患者，并按1:1的比例将其分配至MTH组（33℃）持续24小时或常温组。在入院当天/第1天、第2天和第3天的预定时间点采集血样。评估MTH组和常温组之间以及组内MCP-1水平的差异。此外，分析MCP-1水平与30天全因死亡风险的关联。作为敏感性分析，采用多重填补法处理缺失数据。
结果
MTH组和常温组患者的MCP-1水平随时间存在差异（交互作用P = 0.013）。MTH组第3天的MCP-1水平高于第1天（第1天 vs 第3天：21.2[四分位间距，0.25 - 79.9] vs. 125.7[四分位间距，87.3 - 165.4] pg/mL；P = 0.006），且第3天高于常温组（MTH组125.7[四分位间距，87.3 - 165.4] vs. 常温组12.3[四分位间距，0 - 63.9] pg/mL；P = 0.011）。无论采用何种治疗方法，住院期间MCP-1水平较高的患者30天全因死亡风险往往降低（HR，2.61；95%CI 0.997 - 6.83；P = 0.051）。
结论
与常温对照组相比，MTH的降温阶段对并发AMI的CS患者的MCP-1水平无显著影响，而复温后MCP-1水平显著升高。
试验注册号
NCT01890317。
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