血清中IL-6联合组织相关标志物对AAD的临床诊断价值

Clinical diagnostic value of serum IL-6 combined with tissue related markers in AAD

目的 检测并比较急性主动脉夹层(AAD)、急性冠脉综合征(ACS)患者及健康对照者(HC)血清中炎症因子白细胞介素-6(IL-6)和组织特异性标志物的表达水平,探讨各指标的临床意义。方法 选取泰达国际心血管病医院及厦门大学附属心血管病医院2019年1月至2020年12月收治的61例AAD患者为AAD组,59例ACS患者为ACS组[包括36例急性心肌梗死(AMI组)及23例不稳定性心绞痛(UA组)],同期选择56例HC作为HC组。采集各组研究对象血清并检测IL-6及组织特异性标志物[腱糖蛋白C(TN-C)、基质金属蛋白酶9(MMP-9)、可溶性弹性蛋白片段(sELAF)]的水平,收集D-二聚体(DD)及其他实验室常规检测指标,分析各指标间的相关性及对AAD、ACS(包括AMI、UA)的诊断价值。结果 (1)AAD组血清IL-6、MMP-9、sELAF水平明显高于AMI组、UA组、HC组(P<0.05),AAD组血清TN-C水平明显高于UA组和HC组(P<0.05)。(2)Spearman相关分析显示:血清MMP-9与sELAF、IL-6水平呈正相关(r=0.326、0.277,P<0.01);血清IL-6与sELAF、TN-C水平呈正相关(r=0.167、0.382,P<0.05),血清TN-C与sELAF水平呈正相关(r=0.406,P<0.001)。(3)受试者工作特征(ROC)曲线显示,鉴别AAD与ACS的曲线下面积(AUC)从高到低依次为DD、IL-6、MMP-9、sELAF(AUC分别为0.895、0.835、0.685、0.679,P<0.05)。(4)联合检测时,ROC曲线分析发现最佳早期鉴别诊断AAD与UA的标志物组合为IL-6+sELAF(AUC为0.976,P<0.001)。结论 炎症因子IL-6对AAD的诊断效能优于组织特异性标志物,将IL-6和组织标志物联合检测可以增强对AAD的诊断效能。

Objective To detect and compare the levels of inflammatory cytokine IL-6 and tissue-specific markers in serum of the patients with acute aortic dissection(AAD)patients with acute coronary syndrome(ACS)and healthy controls(HC),and to explore the clinical significance of each indicator.Methods Sixty-one patients with AAD admitted to Teda International Cardiovascular Hospital and Affiliated Cardiovascular Disease Hospital of Xiamen University from January 2019 to December 2020 were selected as the AAD group,and 59 patients with ACS were selected as the ACS group[including 36 cases of acute myocardial infarction(AMI group)and 23 cases of unstable angina pectoris(UA group)].Contemporaneous 56 cases of HC served as the HC group.The basic clinical data were recorded.The serum was collected to detect the levels of IL-6,tissue specific markers[tenascin C(TN-C),matrix metalloproteinase-9(MMP-9),soluble elastin fragments(sELAF)].D-dimer(DD)and other laboratory routine indexes were collected to analyze the correlation among the various indicators and the diagnostic value for AAD and ACS(including AMI and UA).Results(1)The levels of serum IL-6,MMP-9 and sELAF in the AAD group were significantly higher than those in the AMI group,UA group and HC group(P<0.05),and serum TN-C level in the AAD group was significantly higher than that in the UA and HC groups(P<0.05).(2)The Spearman correlation analysis showed that serum MMP-9 was positively correlated with the levels of sELAF and IL-6(r=0.326,0.277,P<0.01),serum IL-6 was positively correlated with the levels of sELAF and TN-C(r=0.167,0.382,P<0.05),serum TN-C was positively correlated with sELAF level(r=0.406,P<0.001).(3)The ROC curve showed that the AUC of distinguishing AAD from ACS from high to low was DD,IL-6,MMP-9 and sELAF(AUC were 0.895,0.835,0.685,0.679,respectively,P<0.05).(4)When the combined detection,the best marker combination for early differential diagnosis in the ADD and UA was IL-6 combined with sELAF(AUC=0.976,P<0.001).Conclusion The diagnostic efficiency of inflammatory cytokine IL-6 is better than the tissue specific markers for AAD.The combined detection of inflammatory cytokine IL-6 and tissue markers could enhance the diagnostic efficiency of AAD.