急性心肌梗死后睡眠呼吸障碍中的炎症与纤维化

Inflammation and Fibrosis in Sleep-Disordered Breathing after Acute Myocardial Infarction.

作者信息

Pec Jan, Buchner Stefan, Fox Henrik, Oldenburg Olaf, Stadler Stefan, Maier Lars S, Arzt Michael, Wagner Stefan

机构信息

Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany.

Department of Internal Medicine, Cham Hospital, 93413 Cham, Germany.

出版信息

Biomedicines. 2024 Jan 11;12(1):154. doi: 10.3390/biomedicines12010154.

DOI:10.3390/biomedicines12010154

PMID:38255259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10813793/

Abstract

BACKGROUND

After acute myocardial infarction (AMI), inflammatory processes promote tissue remodeling at the infarct site. Procollagen III amino-terminal propeptide (PIIINP) is a circulating biomarker of type III collagen synthesis that has been shown to be associated with changes in left ventricular ejection fraction (LVEF) and predicts the occurrence of heart failure after AMI. We hypothesize that sleep-disordered breathing (SDB) promotes inflammation and myocardial fibrosis, leading to reduced myocardial salvage. Therefore, in patients with first-time AMI successfully treated with percutaneous coronary intervention (PCI), we aimed to investigate whether circulating levels of high-sensitivity C-reactive protein (hs-CRP) and PIIINP are elevated in patients with SDB compared to patients without SDB.

METHODS AND RESULTS

This cross-sectional analysis included a total of 88 eligible patients with first AMI and PCI pooled from two prospective studies and stratified according to the apnea-hypopnea index (AHI, with SDB: AHI ≥ 15 h). We analyzed circulating levels of hs-CRP and PIIINP 3-5 days after PCI. Patients with SDB had significantly higher levels of hs-CRP (18.3 mg/L [95% CI, 8.0-42.6] vs. 5.8 mg/L [95% CI, 4.2-19.8], = 0.002) and PIIINP (0.49 U/mL [95% CI, 0.40-0.60] vs. 0.33 U/mL [95% CI, 0.28-0.43], < 0.001). In a multivariable linear regression model accounting for important clinical confounders, SDB significantly predicted circulating levels of hs-CRP ( = 0.028). Similarly, only SDB was independently associated with PIIINP ( < 0.001). Only obstructive but not central AHI correlated with circulating levels of hs-CRP ( = 0.012) and PIIINP ( = 0.006) levels.

CONCLUSIONS

The presence of obstructive SDB after AMI was independently associated with increased circulating levels of hs-CRP and PIIINP. Our results emphasize the important role of SDB as a common comorbidity and indicate increased inflammation and myocardial fibrosis in these patients.

摘要

背景

急性心肌梗死（AMI）后，炎症过程促进梗死部位的组织重塑。前胶原III氨基端前肽（PIIINP）是III型胶原合成的循环生物标志物，已被证明与左心室射血分数（LVEF）的变化相关，并可预测AMI后心力衰竭的发生。我们推测睡眠呼吸紊乱（SDB）会促进炎症和心肌纤维化，导致心肌挽救率降低。因此，在首次AMI成功接受经皮冠状动脉介入治疗（PCI）的患者中，我们旨在研究与无SDB的患者相比，SDB患者的高敏C反应蛋白（hs-CRP）和PIIINP的循环水平是否升高。

方法和结果

这项横断面分析共纳入了88例符合条件的首次AMI和PCI患者，这些患者来自两项前瞻性研究，并根据呼吸暂停低通气指数（AHI，有SDB：AHI≥15次/小时）进行分层。我们在PCI术后3 - 5天分析了hs-CRP和PIIINP的循环水平。有SDB的患者hs-CRP水平显著更高（18.3mg/L [95%CI，8.0 - 42.6] 对比5.8mg/L [95%CI，4.2 - 19.8]，P = 0.002），PIIINP水平也显著更高（0.49U/mL [95%CI，0.40 - 0.60] 对比0.33U/mL [95%CI，0.28 - 0.43]，P < 0.001）。在考虑重要临床混杂因素的多变量线性回归模型中，SDB显著预测了hs-CRP的循环水平（P = 0.028）。同样，只有SDB与PIIINP独立相关（P < 0.001）。只有阻塞性而非中枢性AHI与hs-CRP（P = 0.012）和PIIINP（P = 0.006）的循环水平相关。