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将白细胞介素纳入急性冠状动脉综合征患者诊断和预后生物标志物组合：破解一个多方面的难题。

Integrating the Interleukins in the Biomarker Panel for the Diagnosis and Prognosis of Patients with Acute Coronary Syndromes: Unraveling a Multifaceted Conundrum.

作者信息

Timpau Amalia-Stefana, Miftode Egidia-Gabriela, Costache-Enache Irina-Iuliana, Petris Antoniu-Octavian, Miftode Ionela-Larisa, Mitu Ivona, Miftode Radu-Stefan

机构信息

Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania.

Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania.

出版信息

Diagnostics (Basel). 2025 May 11;15(10):1211. doi: 10.3390/diagnostics15101211.

DOI:10.3390/diagnostics15101211
PMID:40428204
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12110678/
Abstract

Despite the latest advancements in interventional procedures and pharmacological therapy, the incidence of heart failure and death rate following an acute myocardial remain unacceptably high. This study was designed in response to the limited and conflicting literature data regarding the diagnostic and prognostic role of modern inflammatory biomarkers in patients with coronary artery disease. We conducted a case-control, prospective observational study. A total of 145 patients were analyzed, of whom 105 patients had an acute coronary syndrome diagnosis and represented the study group, while 40 patients with a chronic coronary syndrome diagnosis represented the control group. This study investigates the diagnostic and prognostic role of the interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 10 (IL-10), Growth differentiation factor 15 (GDF-15), and classic biomarkers in patients with ischemic coronary heart disease. IL-1β exhibited a prognostic role, being significantly correlated with a left ventricular ejection fraction below 30%. GDF-15 plays a dual role, as a cardio-inflammatory biomarker, being significantly correlated with both N-terminal pro-brain natriuretic peptide (NT-proBNP), and IL-1β, IL-6, and CRP. At the same time, GDF-15 represents a surrogate marker for renal dysfunction. According to the ROC analysis, patients at high mortality risk can be identified with adequate accuracy by cardiac troponin, GDF-15, and IL-10, in addition to NT-proBNP. Logistic regression models confirmed NT-proBNP and IL-10 as mortality predictors. IL-1β stands out for its significant prognostic role, while IL-6 did not demonstrate a diagnostic or prognostic role in acute myocardial infarction patients. IL-10 demonstrated superior predictive value in terms of fatal prognosis compared with the other modern biomarkers. GDF-15 is representative of a multivalent biomarker involved in inflammation, heart failure, and renal dysfunction.

摘要

尽管介入手术和药物治疗取得了最新进展，但急性心肌梗死后心力衰竭的发生率和死亡率仍然高得令人难以接受。本研究是针对关于现代炎症生物标志物在冠状动脉疾病患者中的诊断和预后作用的文献数据有限且相互矛盾而设计的。我们进行了一项病例对照前瞻性观察研究。共分析了145例患者，其中105例诊断为急性冠状动脉综合征，代表研究组，40例诊断为慢性冠状动脉综合征，代表对照组。本研究调查了白细胞介素1β（IL-1β）、白细胞介素6（IL-6）、白细胞介素10（IL-10）、生长分化因子15（GDF-15）以及经典生物标志物在缺血性冠心病患者中的诊断和预后作用。IL-1β具有预后作用，与左心室射血分数低于30%显著相关。GDF-15具有双重作用，作为一种心脏炎症生物标志物，与N末端脑钠肽前体（NT-proBNP）以及IL-1β、IL-6和C反应蛋白（CRP）均显著相关。同时，GDF-15是肾功能不全的替代标志物。根据ROC分析，除NT-proBNP外，心肌肌钙蛋白、GDF-15和IL-10能够以足够的准确性识别高死亡风险患者。逻辑回归模型证实NT-proBNP和IL-10是死亡率预测指标。IL-1β因其显著的预后作用而突出，而IL-6在急性心肌梗死患者中未显示出诊断或预后作用。与其他现代生物标志物相比，IL-10在致命预后方面表现出更高的预测价值。GDF-15代表了一种参与炎症、心力衰竭和肾功能不全过程的多价生物标志物。

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本文引用的文献

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The effect of colchicine on myocardial infarction: An updated systematic review and meta-analysis of randomized controlled trials.秋水仙碱对心肌梗死的影响：一项更新的随机对照试验的系统评价和荟萃分析。
Curr Probl Cardiol. 2025 Jan;50(1):102878. doi: 10.1016/j.cpcardiol.2024.102878. Epub 2024 Oct 10.
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Hepatic T1 mapping as a novel cardio-hepatic axis imaging biomarker early after ST-elevation myocardial infarction.
肝T1映射作为ST段抬高型心肌梗死后早期一种新的心肝轴成像生物标志物。
Eur Heart J Cardiovasc Imaging. 2025 Jan 31;26(2):229-238. doi: 10.1093/ehjci/jeae256.
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2024 ESC Guidelines for the management of chronic coronary syndromes.2024年欧洲心脏病学会慢性冠状动脉综合征管理指南
Eur Heart J. 2024 Sep 29;45(36):3415-3537. doi: 10.1093/eurheartj/ehae177.
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TGF-β Isoforms and GDF-15 in the Development and Progression of Atherosclerosis.TGF-β 异构体和 GDF-15 在动脉粥样硬化的发生和发展中的作用。
Int J Mol Sci. 2024 Feb 9;25(4):2104. doi: 10.3390/ijms25042104.
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The '10 commandments' for the 2023 ESC Guidelines for the management of acute coronary syndromes.2023年欧洲心脏病学会急性冠状动脉综合征管理指南的“十诫”
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Life (Basel). 2023 Jul 27;13(8):1639. doi: 10.3390/life13081639.
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