摘要
目的检测急性ST段抬高心肌梗死(STEMI)患者血清白细胞介素-6(IL-6)、可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)和可溶性P选择素(sP-selectin)水平的变化,探讨其在STEMI患者住院期间死亡的预测作用。方法用ELISA法检测263例初发急性ST段抬高心肌梗死患者血清IL-6、sICAM-1、sVCAM-1和sP-selectin水平,统计分析炎症因子情况与住院死亡的相关性。结果共18例(6.84%)STEMI患者在住院期间死亡;与存活组相比,死亡组平均年龄明显偏高(P<0.001)、女性比例高(P<0.048)、平均体质量指数低(P<0.034)、高血压和2型糖尿病病史多见(P<0.016和P<0.043)。死亡组血清IL-6水平显著高于存活组(P<0.001);死亡组血清sICAM-1、sVCAM-1和sP-selectin水平与存活组差异无统计学意义;用ROC曲线分析血清IL-6水平对住院死亡率的预测价值,曲线下面积为0.787(95%CI:0.678～0.897,P<0.001),血清IL-6水平预测死亡的界值为7.082ng/L;多元Logistic回归分析示年龄≥75岁(P=0.049)和血清高IL-6水平(P=0.019)与住院死亡独立相关。结论STEMI患者住院期间死亡与年龄和血清IL-6水平升高相关,高龄和升高的血清IL-6水平对STEMI患者住院期间死亡均有独立预测价值。
Objective The aim of the present study is to assess the prognostic value of serum interleukin-6 （IL-6）, soluble intercellular adhesion molecule-1 （ slCAM-1 ） , soluble vascular cell adhesion molecule-1 （ sVCAM-1 ） and soluble P-selectin（sP-selectin） on in-hospital mortality in patients with ST-segment elevation acute myocardial infarction（STEMI）. Methods The single-centre study enrolled 263 consecutive patients with STEMI. Data on patients＇ histories, comorbidity, presenting features and reperfusion treatments were collected. In all patients a venous blood sample was taken within 6 hours after symptom onset. Serum levels of IL-6, sICAM-1, sVCAM-1 and sP-selectin were measured by ELISA method. The relation among these inflammatory factors, clinical characteristics and in- hospital mortality were observed and analyzed by SPSS 11.5 package. Results A total of 18 patients died during hospitalization, with a mortality rate of 6.84%. Patients of death group were substantially older than those survival（70.06 vs 60.44, P 〈 0.001 ） , had a higher incidence of hypertension（ P 〈 0. 016） and diabetes mellitus （ P 〈 0. 043 ） , and a lower body mass index （ BMI ） （ P 〈 0. 034 ）. The proportion of female in death group was higher（ P 〈 0. 048 ）. Serum levels of IL-6 in death group were higher than those in survival group （P 〈0. 001 ）. No significant difference of sICAM-1, sVCAM-1 and sP-selectin levels between the two groups was found. ROC curve analysis to predict the risk for in-hospital mortality showed a prognostic accuracy of IL-6 （ AUC 0. 787, 95% CI ： 0. 678 - 0. 897, P 〈 0.001 ） , the optimal cutoff value was 7. 082 ng/L. Predictors of in-hospital mortality at multivariable logistic analysis were IL-6 levels and age（P =0. 019 and 0. 049, respectively）. Conclusion IL-6 levels and age were related to in-hospital mortality of ST-segment elevation acute myocardial infarction, both are independent predictor of in-hospital death in patients with STEMI.
出处
《首都医科大学学报》
CAS
2008年第4期493-496,共4页
Journal of Capital Medical University
基金
北京市自然科学基金(7072032)资助项目~~
