Jia Yu, Li Dongze, Yu Jing, Jiang Wenli, Liu Yi, Li Fanghui, Li Wentao, Zeng Rui, Liao Xiaoyang, Wan Zhi
General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China.
Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China.
Front Cardiovasc Med. 2023 Jan 6;9:1084321. doi: 10.3389/fcvm.2022.1084321. eCollection 2022.
Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency. Both neutrophil granzyme and interleukin (IL)-33/ST2 systems have proven to be effective diagnostic markers for AAD. This study aimed to investigate the relationship between plasma IL-33, soluble suppression of tumorigenesis-2 (sST2), myeloperoxidase (MPO), and matrix metalloproteinase (MMP)-9 levels at admission and all-cause mortality in patients with AAD.
A total of 155 patients with AAD were enrolled from the Prospective Evaluation of Acute Chest Pain (PEACP) study. Plasma concentrations of IL-33, sST2, and MMP-9 were measured using an enzyme-linked immunosorbent assay, and MPO was detected using a chemiluminescence immunoassay. Aortic anatomical parameters were measured using CT radiography. The primary endpoint was all-cause mortality rate.
The median age of the patients was 55 years, and 96 (61.9%) were diagnosed with type A-AAD. After adjusting for confounding factors, the highest tertiles of IL-33, sST2, MPO, and MMP-9 had hazard risks of 0.870 (95% CI: 0.412-1.836, = 0.714), 3.769 (95% CI: 1.504-9.446, = 0.005), 4.689 (95% CI: 1.985-11.076, < 0.001), and 4.748 (95% CI: 1.763-12.784, = 0.002), respectively, compared to the lowest tertile. Pearson's correlation analysis revealed a significant correlation between these markers ( < 0.001). Moreover, sST2, MPO, and MMP-9 levels had a significant positive correlation with aortic diameter and pseudolumen area ( < 0.001).
The biomarkers sST2, MPO, and MMP-9 were independently associated with mortality in patients with AAD. The significant correlation between these biomarkers suggests a pathogenic role for the IL-33/ST2/neutrophil granzyme system in patients with AAD.
急性主动脉夹层（AAD）是一种危及生命的心血管急症。中性粒细胞颗粒酶和白细胞介素（IL）-33/ST2系统已被证明是AAD有效的诊断标志物。本研究旨在探讨AAD患者入院时血浆IL-33、可溶性肿瘤发生抑制因子-2（sST2）、髓过氧化物酶（MPO）和基质金属蛋白酶（MMP）-9水平与全因死亡率之间的关系。
从急性胸痛前瞻性评估（PEACP）研究中纳入了155例AAD患者。采用酶联免疫吸附测定法测量血浆IL-33、sST2和MMP-9的浓度，采用化学发光免疫测定法检测MPO。使用CT放射成像测量主动脉解剖参数。主要终点是全因死亡率。
患者的中位年龄为55岁，96例（61.9%）被诊断为A型主动脉夹层。在调整混杂因素后，与最低三分位数相比，IL-33、sST2、MPO和MMP-9的最高三分位数的风险比分别为0.870（95%CI：0.412-1.836，P = 0.714）、3.769（95%CI：1.504-9.446，P = 0.005）、4.689（95%CI：1.985-11.076，P < 0.001）和4.748（95%CI：1.763-12.784，P = 0.002）。Pearson相关分析显示这些标志物之间存在显著相关性（P < 0.001）。此外，sST2、MPO和MMP-9水平与主动脉直径和假腔面积呈显著正相关（P < 0.001）。
生物标志物sST2、MPO和MMP-9与AAD患者的死亡率独立相关。这些生物标志物之间的显著相关性表明IL-33/ST2/中性粒细胞颗粒酶系统在AAD患者中具有致病作用。
