STEMI患者循环血Th17细胞及相关炎症因子与冠状动脉病变程度及短期预后的相关性

Correlation of circulating Th17 cells and associated inflammatory factors with extent of coronary artery disease and short-term outcome in patients with STEMI

目的探讨循环血中辅助性T细胞17(Th17)及相关炎症因子与急性ST段抬高型心肌梗死(STEMI)患者冠状动脉(冠脉)病变程度和短期预后的相关性。方法回顾性分析2019年1月至12月因急性胸痛于大连市第三人民医院心内科就诊的患者人群,经冠脉造影确诊为冠状动脉粥样硬化性心脏病(冠心病)患者133例,包括STEMI患者76例,稳定性心绞痛(SAP)57例,另有23例冠脉造影呈阴性(正常对照组)。根据冠脉造影结果,将STEMI患者分为单支病变、双支病变和多支病变亚组,记录SYNTAX评分。流式细胞术和ELISA试剂盒检测调节性T细胞(Treg)、Th17和血清白细胞介素-17A(IL-17A)、IL-6、IL-23、转化生长因子-β(TGF-β)。所有STEMI患者完成急诊经皮冠状动脉造影(PCI),记录术后28 d主要心血管不良事件(MACEs)的发生情况及危险因素。结果①与正常对照组和SAP组比较,STEMI组患者Treg细胞百分比和Treg/Th17比值降低,同时Th17细胞百分比和血清IL-17A、IL-6、IL-23水平升高(P<0.05)。②与单支病变亚组和双支病变亚组相比,多支病变亚组STEMI组患者Treg/Th17比值降低,同时Th17细胞百分比和血清IL-17A、IL-6、IL-23、TGF-β水平升高(P<0.05)。③随着冠脉病变程度的加重,STEMI组患者Treg/Th17比值逐渐降低,同时Th17细胞百分比和血清IL-17A、IL-6、IL-23、TGF-β水平逐渐升高(P<0.05)。④经多因素COX回归模型分析,Th17细胞水平(HR=2.467,95%CI:1.731~4.285)、Treg/Th17比值(HR=0.882,95%CI:0.727~0.934)、血清IL-17A(HR=2.993,95%CI:2.184~5.312)和IL-6(HR=1.774,95%CI:1.132~2.078)水平是影响STEMI患者近期预后的独立因素(P<0.05)。结论Th17细胞、Treg/Th17比值及相关的细胞因子(IL-17A、IL-6、IL-23、TGF-β)水平与STEMI的发病、冠脉病变严重程度及短期预后密切相关。

Objective To explore the correlation of helper T-cell 17(Th17)cells in circulating blood,as well as related inflammatory factors,with the extent of coronary artery lesions and short-term prognosis in patients with acute ST segment elevation myocardial infarction(STEMI).Method In this retrospective analysis of the patient population who visited the Department of Cardiology of Dalian Third People's hospital due to acute chest pain from January to December 2019,a total of 133 patients who were diagnosed with coronary artery disease by coronary angiography,including 76 patients with STEMI,57 patients with stable angina pectoris(SAP),and 23 patients who were negative by coronary angiography,were included as the normal control group.STEMI patients were divided into single vessel,double vessel,and multivessel subgroups according to coronary angiography,and the syntax score was recorded.Flow cytometry and ELISA kits were used to detect regulatory T(Treg)cells,Th17 cells and serum levels of interleukin-17A(IL-17A),IL-6,IL-23,and transforming growth factor-β(TGF-β).All STEMI patients completed emergency PCI,and the occurrence of major adverse cardiovascular events(maces)and their risk factors 28 d after the procedure were recorded.Result①Compared with the normal control group and SAP group,the percentage of Treg cells and the ratio of Treg/Th17 in STEMI group were decreased,while the percentage of Th17 cells and serum levels of IL-17A,IL-6 and IL-23 were increased in STEMI group(P<0.05).②Compared with single vessel lesion subgroup and double vessel lesion subgroup,the ratio of Treg/Th17 in STEMI group was lower,while the percentage of Th17 cells and serum levels of IL-17A,IL-6,IL-23 and TGF-βwere increased(P<0.05).③With the severity of coronary artery disease,the ratio of Treg/Th17 decreased gradually in STEMI group,while the percentage of Th17 cells and serum levels of IL-17A,IL-6,IL-23 and TGF-βincreased gradually(P<0.05).④Multivariate Cox regression model analysis showed that Th17 cell level(HR=2.467,95%CI:1.731~4.285),Treg/Th17 ratio(HR=0.882,95%CI:0.727~0.934),serum IL-17A(HR=2.993,95%CI:2.184~5.312)and IL-6(HR=1.774,95%CI:1.132~2.078)were independent factors for the short-term prognosis of STEMI patients(P<0.05).Conclusion Th17 cells,Treg/Th17 ratio as well as related cytokines(IL-17A,IL-6,IL-23,TGF-β)levels are closely associated with the onset of STEMI,severity of coronary lesions,and short-term prognosis.