白细胞介素-6对急性主动脉夹层患者预后的预测价值

Predictive value of interleukin-6 for mortality in patients with acute aortic dissection

目的：探讨白细胞介素-6（IL-6）对急性主动脉夹层患者的预后的预测价值。方法连续入选新疆医科大学第一附属医院心脏中心，2012年1月至2014年2月完全符合诊断标准的主动脉夹层患者87例，用酶联免疫吸附试验（ELISA）检测入院时血浆IL-6。以死亡作为随访终点，随访1年。采用ROC曲线和Cox生存回归分析IL-6对急性主动脉夹层患者死亡的预测价值。结果死亡组患者入院时IL-6高于存活组患者[（17.92±4.61）pg/mlvs.（12.59±2.53）pg/ml，P＜0.001]，且具有统计学意义。ROC曲线分析提示，IL-6对急性主动脉夹层患者死亡具有预测价值（曲线下面积为0.862，95%置信区间=0.81～0.92，P＜0.001），最佳临床分界点为18.36pg/ml，敏感度为87.4%，特异度为70.8%。根据IL-6判断夹层患者死亡的最佳临床分界点（18.36pg/ml），将患者分为IL-6降低组和IL-6升高组。Cox生存回归分析显示，IL-6和急性主动脉夹层患者死亡密切相关[IL-6分组：HR（95%CI）=3.68（1.16～5.42），P＜0.001；IL-6连续变量：HR（95%CI）=1.33（1.14～1.61），P=0.016]，IL-6升高组和IL-6降低组的死亡率具有明显统计学差异（79.1%vs.24.5%，P＜0.001）。结论IL-6对急性主动脉夹层患者预后具有一定预测价值，并且能够识别高危患者。

ObjectiveTo investigate the predictive value of interleukin-6 （IL-6） for mortality in patients with acute aortic dissection.Methods 87 patients diagnosed acute aortic dissection were consecutively enrolled in the study between January, 2012 and, February, 2014. Interleukin-6was detected by enzyme linked immunosorbent assay （ELISA）. The primary endpoint was all-cause death, following up one year. Receiver operating characteristic （ROC） curve and Cox hazard ratio regression were used to analyse the predictive value of IL-6 for mortality in patients with acute aortic dissection. ResultsThe level of IL-6 of patients in the dead group was higher than that in the survival group with significant difference, （17.92±4.61）pg/ml vs. （12.59±2.53）pg/ml,P〈0.001. ROC curve showed IL-6 could predict the mortality of patients with acute AD, a cut-off value was 18.36 pg/ml with sensitivity=87.4% and specificity=70.8%. The patients were divided into two groups： the high IL-6 group and the low IL-6 group. Cox analysis showed that IL-6 was associated with acute aortic dissection mortality （categorical data： HR （95%CI）= 4.26 （2.41-6.34）,P〈0.001; continuous data：HR （95%CI）=1.33 （1.14 to 1.61）,P=0.016. Kaplan-Meier analysis showed that the survival rate was different between the high and low IL-6 group （P〈0.001）.ConclusionIL-6 was a death predictor of patients with acute aortic dissection and could identify high-risk aortic dissection patients.