Mechanisms of C-reactive protein, interleukin-6 and soluble CD40L blood concentration changes after coronary stent implantation

Background: The pathway linking inflammation and thrombosis has been extensively studied. Experimental data support that arterial thrombosis also induces a detectable inflammatory response, which in turn, activates prothrombotic pathways closing a vicious circle that interconnects inflammation and thrombosis. Aim: We designed this study to investigate the causes of inflammatory markers increase after coronary angioplasty. Methods: We analyzed the interrelationship of thrombotic and inflammatory markers and the effect of blocking thrombus formation on the inflammatory response in 50 patients undergoing high thrombotic risk coronary angioplasty. The relationship of platelet number to soluble CD40 Ligand, Interleukin-6 and C-reactive protein blood levels was studied. Half of the study population was treated with standard antithrombotic drugs and the other half with the standard therapy plus platelet GP IIb-IIIa receptor inhibitor Eptifibatide. Results: There was a clear correlation between basal platelet count and sCD40L basal levels, post-angioplasty sCD40L increase and post-angioplasty IL-6 levels and post-angioplasty IL-6 levels with post-angioplasty CRP levels. Postangioplasty CRP, IL-6 and sCD40L blood levels were influenced by GP IIb-IIIa treatment in patients with angiographic thrombus. Conclusion: Platelet aggregation induces a proinflammatory response which is blocked by a GP IIb-IIIa inhibitor agent, particularly in patients with patent angiographic thrombus.

The Role of High-sensitivity C-reactive Protein, Interleukin-6 and Cystatin C in Ischemic Stroke Complicating Atrial Fibrillation

This study examined the role of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and cystatin C in ischemic stroke complicating atrial fibrillation (AF) and the relationship of systemic inflammation with this disease in order to identify AF patients who are at high risk of stroke and need optimal anticoagulant therapy.A total of 103 AF patients, simple (n=75) or complicated by ischemic stroke (n=28), and 112 control subjects were recruited.IL-6 level was detected by using enzyme linked immunosorbent assay.Cystatin C and hsCRP levels were measured by means of a particle-enhanced immunonephelometric assay.The results showed that the AF patients had higher levels of hsCRP (P=0.004), IL-6 (P=0.000), and cystatin C (P=0.000) than control subjects.Plasma hsCRP level was increased in the AF patients with ischemic stroke as compared to the patients with simple AF (P=0.036).The AF patients who had the level of hsCRP exceeding 3.83 mg/L were at a higher risk than those with hsCRP level lower than 3.83 mg/L (P=0.030).After adjusting for other factors, cystatin C remained positively associated with IL-6 (r=0.613) and hsCRP (r=0.488).It was concluded that hsCRP is positively correlated with ischemic stroke complicating AF and may be a risk factor independent of other risk factors for AF.Elevated cystatin C level is also indicative of the increased risk of AF.

C-reactive protein,procalcitonin,interleukin-6,vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer

AIM:The current study was to determine the serum/pLasma levels of VEGF,IL-6,malondialdehyde (MDA),nitric oxide (NO),PCT and CRP in gastric carcinoma and correlation with the stages of the disease and accompanying infection. METHODS:We examined the levels of serum VEGF,IL-6, PCT,CRP and plasma MDA,NO in 42 preoperative gastric cancer patients and 23 healthy subjects.There were infection anamneses that had no definite origin in 19 cancer patients. RESULTS:The VEGF levels (mean±SD; pg/mL) were 478.05±178.29 and 473.85±131.24 in gastric cancer patients with and without infection,respectively,and these values were not significantly different (P>0.05).The levels of VEGF, CRP,PCT,It-6,MDA and NO in cancer patients were significantly higher than those in healthy controls and the levels of CRP,PCT,It-6,MDA and NO were statistically increased in infection group when compared with non- infection group (P<0.001). CONCLUSION:Although serum VEGF concentrations were increased in gastric cancer,this increase might not be related to infection.CRP,PCT,IL-6,MDA and NO have obvious drawbacks in the diagnosis of infections in cancer patients. These markers may not help to identify infections in the primary evaluation of cancer patients and hence to avoid unnecessary antibiotic treatments as well as hospitalization. According to the results of this study,IL-6,MDA,NO and especially VEGF can be used as useful parameters to diagnose and grade gastric cancer.

Diagnostic value of serum Interleukin-6 combined with synovial IL-6 and C-reactive protein for prosthesis joint infection in patients after joint arthroplasty

Objective:To explore the diagnostic value of serum Interleukin-6(IL-6)combined with synovial IL-6 and C-reactive protein for prosthesis joint infection(PJI)in patients after joint arthroplasty.Methods:A total of 253 patients undergoing revision surgery after the first total hip and total knee arthroplasty in the Second Affiliated Hospital of Hainan Medical College from January 2018 to April 2020 were recruited as the study object.The patients were divided into the PJI group(n=85)and non-PJI group(n=168)according to whether there was PJI,and the baseline characteristics and the laboratory indexe were collected and compared between the two groups.the factors associated with PJI in patients after joint arthroplasty were analyzed by multivariate logistic regression model.And the diagnostic value of each marker for PJI in patients after joint arthroplasty was evaluated by Receiver Operating Characteristic(ROC)curve.Results:The incidence of PJI in this study was 33.6%.Compared with the non-PJI group,the patients in the PJI group had more diabetes mellitus and shorter prosthesis duration(P<0.05).The levels of serum C-reactive protein(CRP),serum interleukin-6(IL-6),synovial IL-6,synovial CRP,synovial leukocyte,synovial neutrophil and ESR in the PJI group were higher than those in non-PJI group,and the level of synovial lymphocyte was lower,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus(OR=1.706,95%CI:1.02~2.376,P=0.037),prosthesis duration(OR=0.781,95%CI:0.690~0.884,P<0.001),serum IL-6(OR=1.008,95%CI:1.004~1.012,P=0.046),synovial IL-6(OR=1.004,95%CI:1.002~1.006,P=0.011)and synovial CRP(OR=1.481,95%CI:1.010~2.170,P=0.044)were independently related to PJI in patients after joint arthroplasty.ROC curve analysis showed that the area under ROC curve(AUC)of serum IL-6 combined with synovial IL-6 and CRP for diagnose PJI in patients after joint arthroplasty was significantly greater than each marker(0.941 vs 0.760,Z=6.333,P<0.001;0.941 vs 0.743,Z=7.189,P<0.001;0.941 vs 0.785,Z=4.999,P=0.006).Conclusion:Serum IL-6,synovial IL-6 and CRP were independently related to PJI in patients after joint arthroplasty.They all had some diagnostic value,and serum IL-6 combined with synovial IL-6 and CRP had higher capability to diagnose PJI in patients after joint arthroplasty than each marker alone.

Association between Metabolic Syndrome Components and Serum High-Sensitivity C-Reactive Protein or Interleukin-6 Levels among Congolese Adults

Metabolic syndrome (MetS) and its components have been linked to elevated serum levels of inflammatory biomarkers such as C-reactive protein, interleukin-6, interleukin-1β and tumor necrosis factor alpha. The aim of our study was to address the association between MetS components with serum hs-CRP and IL-6 levels among Congolese adults. A total of 357 participants (aged 30 - 87 years) were included in this cross-sectional study. Anthropometrics were collected and fasting blood sampled for assessment of fasting blood glycaemia (FBG), lipids and inflammatory parameters using commercially available assays. NCEP-ATPIII criteria were used to define MetS. The Median (IQR) hs-CRP and IL-6 levels were higher in participants with MetS than in those without ([7 (4, 14) versus 6 (4, 8)] mg/L;p = 0.092 and [23.8 (20.9, 27.6) versus 22.3 (19.5, 25.0)] pg/mL;p = 0.002). hs-CRP and IL-6 levels were significantly higher in females with MetS than in those without, but not in males. Among participants, only TG was correlated with hs-CRP (r = 0.149, p = 0.007), and a significant correlation was observed between TG (r = 0.116, p = 0.037), FBG (r = 0.208, p = 0.000), HDL-C (r = −0.119, p = 0.034) and SBP (r = 0.143, p = 0.010) and IL-6. In males, hs-CRP levels were positively correlated with TG (0.316;p = 0.000), negatively with HDL-C (r = −0.290, p = 0.0022), without such correlations in females. In Ames, IL-6 levels were positively correlated with FBG (r = 0.202;p = 0.035), and negatively with HDL-C (r = −0.249, p = 0.009). Significant correlations between IL-6 levels and FBG (r = 0.214;p = 0.000) or SBP (r = 0.227, p = 0.000) were observed in females. Logistic regression analysis was carried out to identify the relationship between MetS components and hs-CRP or IL-6. Values of area under receiver-operating characteristic (ROC) curves suggest potential use of serum hs-CRP (AUC = 0.675) and IL-6 (AUC = 0.656) as diagnostic biomarkers of MetS. Combination of hs-CRP and IL-6 improved diagnosis accuracy, yielding a 0.698 ROC curve area. MetS components are associated with hs-CRP and IL-6 levels among adults Congolese. Combining the two biomarkers hs-CRP and IL-6 improves Mets diagnostic accuracy compared to hs-CRP or IL-6 alone.

Effect of flurbiprofen combined with prednisolone on interleukin-6 in elderly surgery patients

Objective: To determine the effect of flurbiprofen combined with prednisolone on interleukin-6 in elderly surgery patients. Methods: In this double-blind randomized controlled study, patients aged 65 to 80 who were undergoing spinal fusion surgery for disc herniation were administered flurbiprofen 100 mg (P group, flurbiprofen group), prednisolone 0.6 mg/kg (D group, prednisolone group), prednisolone 0.6 mg/kg plus flurbiprofen 100 mg (P + D group, flurbiprofen + prednisolone group) or normal saline (S group, saline group) 15 minutes before the induction of anesthesia. Plasma samples were collected before surgery (T0) and on day 1 (T1), day 2 (T2) and day 3 (T3) following surgery. At the same time, systemic inflammatory response syndrome (SIRS) was assessed by SIRS criteria. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) for collected samples were measured. Results: Other groups had significantly lower levels of IL-6, CRP and occurrence of SIRS than S group (p < 0.05). Compared to groups P and D, the levels of IL-6 and CRP in P + D group were significantly lower on T1 (p < 0.05). Peak levels of IL-6 in all groups were presented on T1 (p 0.05). The levels of CRP within three days were significantly different but did not show peak levels (p > 0.05). Conclusion: Compared to prednisolone or flurbiprofen, combining flurbiprofen with prednisolone in elderly surgery patients led to an increased suppression of IL-6.

CHANGES OF INTERLEUKIN-6 AND RELATED FACTORS AS WELL AS GASTRIC INTRAMUCOSAL pH DURING COLORECTAL AND ORTHOPAEDIC SURGICAL PROCEDURES

Objective To investigate the changes of perioperative serum levels of interleukin-6(IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. Methods Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation.Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol.pHi and plasma lactate were also measured at the same time points.Results Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation.CRP was not detectable until the first day after operation.Peak concentration of IL-6 had positive relationship with CRP.These variables changed more significantly in colorectal group than that in orthopaedic group (P<0.05).pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P<0.05).Conclusion IL-6 may reflect tissue damage more sensitively than CRP.Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.

Relationship between coronary atherosclerosis plaque characteristics and high sensitivity C-reactive proteins, interleukin-6

Background The relationship between inflammatory markers and the characteristics of coronary atherosclerosis plaques is uncertain. The aim of the present study was to evaluate the relationship between the characteristics of coronary atherosclerosis plaques and inflammatory markers such as high sensitivity C-reactive proteins （Hs-CRP） and interleukin-6 （IL-6）. Methods All patients suspected of having coronary heart disease （CHD） underwent Siemens 64-slice CT angiography （64-SCTA） to distinguish the quality of plaque of coronary artery lesions. Blood samples were taken to measure levels of serum Hs-CRP and IL-6 in different plaque groups and the control group and compared with the value of 64-SCTA for detection of coronary artery plaque. Results The sensitivity of detecting coronary artery plaque by 64-SCTA was 87.4%, the specificity was 87.1%, the positive predictive value was 82.2%, and the negative predictive value was 91.0%. Comparing the levels of serum Hs-CRP and IL-6 among plaque groups, the mean levels of serum Hs-CRP and IL-6 in three plaque groups were significantly higher than those in the control group （P 〈0.01）. The mean levels of serum Hs-CRP and IL-6 in the soft plaque group and mixed plaque group were significantly higher than those in hard plaque group （P〈0.01）. Plaque burden in the soft plaque group and mixed plaque group was significantly higher than in the hard plaque group （P 〈0.01）, but there was no statistical difference between the soft plaque group and mixed plaque group （P=-0.246）. There was a negative correlation between the CT scale and Hs-CRP and IL-6 levels in the soft plaque group （r= -0.621, P〈0.01, and r= -0.593, P 〈0.01 respectively）. There was a positive correlation between the plaque burden and Hs-CRP and IL-6 levels in the soft plaque group （r=0.579, P〈0.05 and r=0.429, P〈0.05 respectively）. Conclusions 64-SCTA is an effective way to distinguish the different quality of coronary atherosclerosis plaque. Serum Hs-CRP and IL-6 levels can be considered as the indexes to judge the degree of CHD and may reflect the activity of plaque in CHD patients. Thus it is important for clinical diagnosis and risk evaluation of acute coronary syndrome （ACS） patients.

Association of interleukin-6 and C-reactive protein genetic polymorphisms levels with venous thromboembolism

Background Increased levels of interleukin-6 （IL-6） and C-reactive protein （CRP） have been reported in patients with venous thromboembolisms （VTE）. However, prospective studies did not confirm an association between IL-6, CRP and their polymorphism with the risk of VTE. Methods One hundred and forty patients （including 66 males and 74 females, mean age （55.55±17.11） years） and one hundred and sixty controls （including 74 males and 86 females, mean age （56.58±12.24） years） were involved. An enzyme linked immunosorbent assay （ELISA） method was used for detecting the serum levels of inflammatory factors IL-6 and CRP in both groups. Polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP） was used for analyzing the distribution of polymorphisms at the -572C/G and -597G/A sites of the promoter of the IL-6 gene and at 1059G/C of the CRP gene. Results Serum levels of IL-6 and CRP were significantly higher in the VTE group than in the control group （P 〈0.05）. The frequencies of-572C/G promoter polymorphisms CC, CG, and GG in the IL-6 gene were found to be 34%, 48%, and 18%, respectively, and the derived allele frequencies for the C and G alleles were 58% and 42%. There was a significant difference in the -572C/G promoter polymorphisms between the VTE group and control group （P 〈0.05）. For the -597G/A polymorphism, individuals all carried the GG and GA type; AA genotypes were not detected. The frequency of the GG, GC, and CC genotypes at the CRP1059G/C promoter was 87.57%, 7.86% and 3.57% in V-rE group, while 86.25%, 10%, and 3.75% in control group, respectively. The frequency of G and C alleles at CRP 1059G/C was 91.43% and 8.57% in VTE group and 91.56% and 8.44% in the control group. The results showed that there was no statistically significant difference of 1059G/C genotype and mutation frequency of the allele between the VTE group and control group （P 〉0.05）. Multiple Logistic regression analysis showed CC homozygotes of the IL-6 -572G/C, body mass index （BMI）, and CRP, IL-6, and high-density lipoprotein cholesterol （HDL-C） were independent risk factors for VTE （P 〈0.05）. Conclusions We found that V-rE was associated with IL-6 and CRP levels, and there was an association of IL-6 and its promoter polymorphism at -572G/C with the risk of VTE. Thus far, a causal relationship between inflammation and VTE remains to be clarified and more prospective data are required.

Role of IL-6 in the contraceptive mechanism of intrauterine device

目的 :探讨血清中白细胞介素 - 6(IL- 6)水平与宫内节育器 (IUD)存在的关系。方法 :采用酶联免疫吸附试验测定 64例置器妇女 (试验组 ,试验组又分为置器出血组和无出血组 ) ,以及60例健康妇女 (对照组 )血清中 IL- 6水平 ,同时测定两组血清中 C-反应蛋白 (CRP)水平。结果 :试验组 64例中有 31例血中 IL- 6水平升高 ,与对照组相比差异显著 (P<0 .0 1 )。但其中置器出血组与不出血组中 IL- 6水平无统计学差异 (P>0 .0 5)。试验组及对照组血清中 CRP检验结果均为阴性。结论 :宫内节育器引起子宫内膜无菌性炎症反应 ,导致部分妇女血清中 IL- 6水平升高。IL-

Correlation study of sleep efficiency with C-reactive protein and IL-6 in patients with infective endocarditis

Background Sleep disorders have been found in patients with infective endocarditis(IE)and are reported to have a strong correlation with inflammation. In this study,we measured the serum levels of inflammatory factors and evaluated the correlations of postoperative sleep efficiency with C-reactive protein and interleukin-6(IL-6)in IE patients. Methods A total of 117 post-operative patients with IE were enrolled in the study. All patients were tested using a wearable actigraphy device for their sleep efficiency. All patients were examined for C-reactive protein,and 72 patients were tested for IL-6. Results A correlation analysis was performed between C-reactive protein and IL-6. The average sleep efficiency of most of the IE patients was 80.81±8.52%,and the average result of the C-reactive protein test was 29.98±26.3 mg/L. The correlation coefficient between sleep efficiency and C-reactive protein was-0.3011. The average result of the IL-6 test was 24.52±23.85 pg/mL,and the correlation coefficient between sleep efficiency and IL-6 was-0.3543. Conclusions Postoperative sleep efficiency is negatively correlated with serum levels of C-reactiveprotein and IL-6 in patients with IE.[S Chin J Cardiol2019;20(2):103-107]

Serum procalcitonin and interleukin-6 levels may help to differentiate systemic inflammatory response of infectious and non-infectious origin

To evaluate the efficacy of using procalcitonin (PCT) and interleukin-6 (IL-6) to differentiate sepsis from non-infectious systemic inflammatory response syndrome (SIRS) Methods We made a prospective study in a general intensive care unit at Peking Union Medical College Hospital Twenty patients with sepsis and 31 patients with non-infectious SIRS were enrolled in this study Serum concentrations of PCT, IL-6 and C-reactive protein (CRP) were determined within 24 h after clinical onset of sepsis or non-infectious SIRS Leukocyte count, percentage of neutrophils, and absolute neutrophil count, as well as maximal body temperature were also recorded Results Serum concentrations of PCT, IL-6, and CRP, as well as maximal body temperature, were significantly higher in septic patients [3 6 (1 8, 27 5) μg/L, 810±516 ng/L, 180±108 g/L, 38 6±1 2℃] than non-infectious SIRS patients [0 5 (0 2, 1 8) μg/L, 235±177 ng/L, 109±70 g/L, 37 9±0 9℃] IL-6 and PCT exhibited the best discriminative power between sepsis and non-infectious SIRS, with sensitivity above 80% and specificity above 70% A sepsis score with combination of IL-6 and PCT showed the best discriminative power with the area under the receiver operating characteristic curve of 0 923 Conclusions Assessing IL-6 and PCT levels are more reliable ways to differentiate sepsis from non-infectious SIRS, compared with conventional inflammatory parameters

Clinicopathologic significance of expression of nuclear factor-kB RelA and its target gene products in gastric cancer patients

AIM:To assess the prognostic significance of nuclear factor-kB (NF-kB) and its target genes in gastric cancer. METHODS:The tumor tissues of 115 patients with gastric cancer were immunohistochemically evaluated using monoclonal antibodies against NF-kB RelA. Preoperative serum levels of vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) were assessed via enzyme-linked immuno-sorbent assay. C-reactive protein (CRP) and serum amyloid A (SAA) were measured via immunotrubidimetry. RESULTS:Positive rate of NF-kB RelA was 42.6%. NF-kB RelA expression in tumor tissues was also related to serum levels of IL-6 (P = 0.044) and CRP (P = 0.010). IL-6, SAA, CRP were related to depth of invasion, VEGF and SAA were correlated with lymph node metastasis. IL-6, VEGF, SAA and CRP were related to the stage. Univariate analysis demonstrated that immunostaining of NF-kB RelA, levels of IL-6, VEGF, SAA were significantly related with both disease free survival and over-all survival (OS). Multivariate analysis verified that NF-kB RelA [hazard ratio (HR): 3.40, P = 0.024] and SAA (HR: 3.39, P = 0.045) were independently associated with OS. CONCLUSION: Increased expression of NF-kB RelA and high levels of serum SAA were associated with poor OS in gastric cancer patients.

Markers of systemic inflammation and colorectal adenoma risk: Meta-analysis of observational studies

To perform a meta-analysis of observational studies on inflammatory markers levels and occurrence of colorectal adenoma.METHODSPubMed and EMBASE databases were searched until March 2016 for the articles reporting on the circulating levels of inflammatory markers, including: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and risk of colorectal adenoma. Random-effects models were used to calculate summary odds ratios (ORs) with 95%CIs for the highest vs lowest category of exposure. Heterogeneity was assessed by using the Q test and I2 statistic. Subgroup analyses were also performed to test for potential source of heterogeneity.RESULTSA total of 14 case-control studies were included. Ten studies on CRP including a total of 3350 cases and 4168 controls showed non-significant summary (OR = 1.23, 95%CI: 0.98-1.54; I2 = 54%, Pheterogeneity = 0.01) in the general analysis, but significant increased odds when considering only advanced adenoma (OR = 1.59, 95%CI: 1.09-2.32; I2 = 44%, Pheterogeneity = 0.15). Subgroup and stratified analyses revealed a potential influence of smoking status and aspirin use on the association between CRP levels and colorectal adenoma. Five studies examined the association between circulating levels of TNF-α and colorectal adenoma risk, including a total of 1,568 cases and 2,832 controls. The summary OR for the highest vs the lowest category of exposure was 1.00 (95%CI: 0.77-1.29). The relationship between circulating IL-6 levels and colorectal adenoma risk was investigated in 7 studies including a total of 1936 cases and 3611 controls. The summary OR for the highest vs the lowest category of exposure was 1.19 (95%CI: 0.92-1.55).CONCLUSIONSummary of current evidence suggests a positive association of CRP levels and advanced colorectal adenoma risk. The role of potential confounding factors should be further evaluated.

Low T3 syndrome and long-term mortality in chronic hemodialysis patients

AIM： To investigate the predictive value of low freeT3 for long-term mortality in chronic hemodialysis （HD） patients and explore a possible causative role of chronic infammation.METHODS： One hundred fourteen HD patients （84 males） consecutively entered the study and were assessed for thyroid function and two established markers of inflammation, high sensitivity C-reactive protein （hsCRP） and interleukin-6 （IL-6）. Monthly blood samples were obtained from all patients for three consecutive months during the observation period for evaluation of thyroid function and measurement of infammatory markers. The patients were then divided in two groups based on the cut-off value of 1.8 pg/mL for mean plasma freeT3, and were prospectively studied for a mean of 50.3 ± 30.8 mo regarding cumulative survival. The prognostic power of low serum fT3 levels for mortality was assessed using the Kaplan-Meier method and univariate and multivariate regression analysis.RESULTS： Kaplan-Meier survival curve showed a negative predictive power for low freeT3. In Cox regression analysis low freeT3 remained a significant predictor of mortality after adjustment for age, diabetes mellitus, hypertension, hsCRP, serum creatinine and albumin. Regarding the possible association with inflammation, freeT3 was correlated with hsCRP, but not IL-6, and only at the frst month of the study.CONCLUSION： In chronic hemodialysis patients, low plasma freeT3 is a significant predictor of all-cause mortality. Further studies are required to identify the underlying mechanisms of this association.

Visfatin levels in patients with severe pneumonia

BACKGROUND： As a cytokine highly expressed in internal organs, visfatin could be used as a biomarker of systemic inflammation response for chronic obstructive pulmonary diseases, but few studies have reported the use of visfatin in severe pneumonia. The present study was undertaken to determine the plasma levels of visfatin in patients with severe pneumonia. METHODS：A total of 70 patients, including 40 patients with severe pneumonia （group A） and 30 patients with non severe pneumonia （group B） who had been admitted to the ICU from June 2009 to June 2010, were enrolled in this prospective study. And another 30 healthy physical examinees served as healthy controls （group C）. Patients were excluded if they suffered from severe diseases of the heart, brain and kidney, cancers, autoimmune diseases, or received special treatment in the latest month. The plasma levels of visfatin, IL-6, IL-8 and TNF-α were measured by ELISA, while the level of CRP was determined by immuneturbidimetry, and the routine blood test was performed. Blood gas analysis and Acute Physiology and Chronic Health Evaluation II （APACHE II） were performed in patients with pneumonia. Comparisons between the groups were conducted by Student＇s t test, ANOVA or nonparametric test. Correlation analysis was carried out by Pearson＇s correlation test or Spearman＇s rank-order correlation test. RESULTS：The plasma level of visfatin in group A was significantly higher than that in groups B and C （P〈0.001）, and the level of visfatin in group B was significantly higher than that in group C （P〈0.001）. The plasma level of visfatin was positively correlated with CRP, TNF-α, APACHE II and PMN% in patients with severe pneumonia （rho=0.653, r=0.554, r=0.558, r=0.484, respectively, P〈0.05 for all）, while it was negatively correlated with PaO2 and PaO2/FiO2 （rho=-0.422, r=-0.543, respectively, P〈0.05 for all）. CONCLUSION：Visfatin may be involved in the systematic inflammation response in patients with severe pneumonia as a pro-inflammatory cytokine, and it is valuable in assessing the severity of pneumonia..

Comparative evaluation of surgical stress of different lymph node dissection for gastric cancer

Objective: To evaluate the effects of surgical trauma of open surgery on the patients with gastric carcinoma who underwent different lymph node dissection. Methods:Total 30 patients with gastric carcinoma were divided into three groups (D1, D2, and D3) according to the extent of lymph node dissection. Peripheral blood samples were taken to measure the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP) and polymorphonuclear elastase (PMNE). Ad- ditionally, leucocytes and lymphocytes counts in peripheral serum were also detected. Results: All the three groups showed a significant increase of the levels of IL-6, IL-8, CRP and PMNE after operation. There was no significant difference between D1 and D2 groups. When the comparison was made between D3 group and the other two groups, it showed higher concentration of IL-6, IL-8, CRP and PMNE in serum of D3 group. Leucocytes count showed no difference among the three groups. After operation, the patients in three groups had transient lymphocytes decrease on the second and third postoperative days, the lymphocytes count in D3 group was still lower while those in D1 and D2 groups began to increase. Conclusion: IL-6, IL-8, CRP and PMNE can be used to monitor surgical stress. Using these parameters, we found that extended lymph node dissec- tion of D3 group led to more postoperative stress than D1 and D2 groups.

Effects of insulin aspart and metformin on gestational diabetes mellitus and inflammatory markers

BACKGROUND Gestational diabetes mellitus(GDM)refers to hyperglycemia caused by insulin resistance or insufficient insulin secretion during pregnancy.Patients with GDM have a high risk of pregnancy complications,which can adversely affect both maternal and fetal health.Therefore,early diagnosis,treatment and monitoring of GDM are essential.In recent years,a new treatment scheme represented by insulin aspart combined with metformin has received increasing attention.AIM To explore the effects of insulin aspart combined with metformin on patients with GDM and inflammatory markers.METHODS From April 2020 to September 2022,124 patients with GDM in Sanya Women and Children’s Hospital Managed by Shanghai Children’s Medical Center were collected and analyzed retrospectively.The control group(CG)comprised 62 patients treated with insulin aspart alone,and 62 patients treated with insulin aspart and metformin formed the observation group(OG).Before and after treatment,improvement of blood-glucose-related indexes[fasting blood glucose(FBG),2-h postprandial glucose(2h PG)and hemoglobin A1c(HbA1c)],serum related factor[serum homocysteine(Hcy)],serum inflammatory cytokines[tumor necrosis factor(TNF)-α,interleukin(IL)-6 and C-reactive protein(CRP)]were compared between the two groups.The clinical efficacy,adverse pregnancy outcomes and incidence of pregnancy complications were compared between the two groups.RESULTS After treatment,the levels of FBG,2h PG,HbA1c,Hcy,TNF-α,IL-6 and CRP in both groups were significantly decreased(P<0.05),and the levels of FBG,2h PG,HbA1c,Hcy,TNF-α,IL-6 and CRP in the OG were lower than in the CG(P<0.05).The total clinical effectiveness in the OG was higher than that in the CG(P<0.05).The total incidence of adverse pregnancy outcomes and complications in the OG was significantly lower than in the CG(P<0.05).CONCLUSION Insulin aspart combined with metformin are effective for treatment of GDM,which can reduce blood-glucoserelated indexes,Hcy and serum inflammatory cytokines,and risk of adverse pregnancy outcomes and complications.

Inflammatory markers and elderly patients with stroke

C-reactive protein (CRP) is associated with unfavorable outcome in patients with acute ischemic syndromes and in patients with chronic stable angina.Elevated CRP levels suggestive of heightened inflammatory state in vascular conditions are often associated with elevated interleukin-6 (IL-6) levels.The aim of our study was to show the predictive importance of CRP and IL-6 levels in patients with ischemic stroke that has not been fully elucidated.Design We studied 647 consecutive elderly patients (>65 years) with stroke who were documented with ischemic stroke,presence of significant carotid atherosderosis and absence of atrial fibrillation.The study population included 150 patients (74 men,76 women,mean age 74±2).Patients underwent evaluation of high sensitive CRP and IL-6 levels at baseline,during hospitalization and at discharge.Results In-hospital mortality was 6%,1 year mertality was 15% and a second cerebrovascular event occurred in 12% of patients.Those with in- hospital events had significantly higher baseline CRP and IL-6 levels than patients without events (3.8+1.1 vs 1.9±0.9 mg/L,P<0.01 and 13.8±3.4 vs 6.3±2.1 pg/ml,P<0.01,respectively).Also CRP and IL-6 levels were significantly higher in those patients with an event within 3 months of discharge compared to patients without an event (3.6±1.3 vs 1.1±0.7 mg/L,P<0.01 and 14.2±3.7 vs 5.4±1.6 pg/ml,P<001, respectively).Both base line CRP levels and IL-6 were predictive of events both in-hospital and after 3 months while CRP and IL-6 levels at baseline were not associated with a poor 1 year prognosis.Elevated CRP levels were associated with an unfavorable outcome only when IL-6 levels were also elevated.In a stepwise multivariate analysis IL-6 level was a stronger predictor of outcome than CRP.Conclusions In conclusion,elevated CRP and IL-6 levels may identify elderly patients at increased medium term risk,but do not predict one year events in this subset of patients.CRP levels predict events only when they are coupled with IL-6 levels.(J Ceriatr Cardiol 2004;1:44- 48.)

Research Progress of Echocardiography Combined with Blood Related Detection Indexes in the Diagnosis and Treatment of Kawasaki Disease in Children

Aim: To explore the research progress of echocardiography combined with blood-related detection indicators in the diagnosis and treatment of Kawasaki disease in children. By collecting relevant literature reports, echocardiography and several blood-related detection indicators such as SAA, IL-6, PCT and CRP were screened out. It has good clinical application value in the clinical diagnosis and treatment of Kawasaki disease in children, but there is no report on the application of echocardiography combined with blood SAA, IL-6, PCT and CRP detection in the diagnosis and treatment of Kawasaki disease in children. The author intends to explore the role of echocardiography combined with blood SAA, IL-6, PCT and CRP detection in the diagnosis and treatment of Kawasaki disease in children, hoping to achieve better results.