急性ST段抬高型心肌梗死患者冠状动脉“罪犯血管”内血清白细胞介素-27浓度的临床意义

Clinical significance of serum concentration of interleukin-27 in coronary culprit artery in patients with acute ST-segment elevated myocardial infarction

目的探讨白细胞介素-27(interleukin,IL-27)与急性ST段抬高型心肌梗死(acute ST-segment elevated myocardial infarction,ASTEMI)经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后患者院内主要不良心血管事件(major adverse cardiovascular events,MACE)的关系。方法采用前瞻性研究方法,纳入2017年8月1日至2019年12月31日在广东省第二人民医院就诊并成功行急诊PCI治疗的急性心肌梗死患者210例,收集患者入院时临床基本资料,记录缺血再灌注时间并同时抽取冠状动脉“罪犯血管”(coronary culprit artery,CCA)内血样,以及住院期间心律失常、心肌梗死后心绞痛、心力衰竭及死亡等MACE。酶联免疫吸附试验法检测CCA内血清IL-27浓度。根据是否发生MACE分为MACE组和非MACE组。分析CCA内血清IL-27浓度在MACE中的预测价值。结果与非MACE组患者相比,MACE组患者在住院期间利尿药使用比例、入院时泵功能(Killip)Ⅲ~Ⅳ级比例,血清肌酐(Cr)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、N末端脑钠肽前体(NT-proBNP)、超敏心肌肌钙蛋白I(hs-cTnI)、CCA内血清IL-27浓度及Gensini评分升高,左心室射血分数(LVEF)降低,差异有统计学意义(P<0.05)。预测ASTEMI患者住院内发生MACE的受试者工作特征曲线(receiver operating characteristic curve,ROC)结果显示,CCA内血清IL-27浓度曲线下面积最大为0.890(95%CI:0.819~0.961),预测住院期间MACE的敏感度为0.756,特异度为0.915。结论CCA内血清IL-27浓度对急性心肌梗死缺血再灌注患者治疗后院内MACE具有一定的预测价值。

Objectives To investigate the relationship between interleukin-27(IL-27)and major adverse cardiovascular events(MACE)in patients with acute ST-segment elevated myocardial infarction(ASTEMI)in hospital after percutaneous coronary intervention(PCI).Methods Totally 210 patients with ASTEMI successfully underwent emergency PCI were hospitalized in The Second General People's Hospital of Guangdong Province and enrolled in this study using prospective research methods from August 1,2017 to December 31,2019.The basic clinical data of the patients,the duration of ischemia-reperfusion,the blood samples of the coronary culprit artery(CCA)were collected,as well as MACE such as arrhythmia,angina pectoris,heart failure and cardiogenic death were recorded in hospital.The serum concentration of IL-27 in CCA was detected by enzyme-linked immunosorbent assay.According to whether MACE occurs or not,the patients were divided into MACE group and non-MACE group.The predictive value of IL-27 in MACE was analyzed.Results Compared to non-MACE group,the application ratio of diuretics during hospitalization,the ratio of Killip Ⅲ-Ⅳ heart function grades,serum concentrations of creatinine(Cr),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),N-terminal pro-brain natriuretic peptide(NT-proBNP),hypersensitivity myocardial troponin I(hs-cTnI),CCA serum concentration of IL-27 and Gensini score in MACE group significantly increased,but left ventricular ejection fraction(LVEF)significantly decreased in MACE group,and the differences were statistically significant(P<0.05).The under area of receiver operating characteristic curve(ROC)of the CCA serum concentration of IL-27 predicting MACE in hospitalization for patients with ASTEMI underwent PCI was 0.890,which was the largest.The optimal sensitivity and specificity were 0.756 and 0.915,respectively.Conclusions The CCA serum concentration of IL-27 has good clinical prediction value for MACE in hospitalization for patients with ASTEMI underwent PCI.