急性ST段抬高型心肌梗死患者炎性因子水平与不良心血管事件发生的关系

doi:10.3969/j.issn.1006-7795.2025.06.013

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (6): 1055-1064.doi: 10.3969/j.issn.1006-7795.2025.06.013

急性ST段抬高型心肌梗死患者炎性因子水平与不良心血管事件发生的关系

吴箴言，江雪，郭新颖，张洁，刘建，郭彩霞^*

首都医科大学附属北京同仁医院心血管中心，北京 100176

收稿日期:2025-08-28 修回日期:2025-09-29 出版日期:2025-12-21 发布日期:2025-12-19
通讯作者: 郭彩霞 E-mail:cxgbb@163.com
基金资助:
北京市自然科学基金项目 (7232022)，国家自然科学基金项目 (82171808, 82200369)，首都卫生发展科研专项 (2024-1-2051)，北京市高层次公共卫生技术人才项目-领军人才 (领军人才-03-02)，首都医科大学临床专科学院 (系) 培养基金项目 (CCMU2022ZKYXY004)，首都医科大学附属北京同仁医院科研种子基金资助项目 (2022-YJJ-ZZL-015, 2021-YJJ-ZZL-001)。

The association between the inflammatory cytokine levels and occurrence of adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction

Wu Zhenyan, Jiang Xue, Guo Xinying, Zhang Jie, Liu Jian, Guo Caixia^*

Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100176，China

Received:2025-08-28 Revised:2025-09-29 Online:2025-12-21 Published:2025-12-19
Supported by:
This study was supported by Natural Science Foundation of Beijing (7232022), National Natural Science Foundation of China (82171808, 82200369), Capital's Funds for Health Improvement and Research (2024-1-2051), the Leading Talent Program in High-level Public Health Technical Talents of Beijing (Lingjunrencai-03-02), the Basic-Clinical Cooperation Program from Capital Medical University (CCMU2022ZKYXY004), and the Priming Scientific Research Foundation for the Junior Researcher in Beijing Tongren Hospital, Capital Medical University (2022-YJJ-ZZL-015, 2021-YJJ-ZZL-001).

摘要/Abstract

摘要： 目的探讨炎性因子水平与ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)患者住院期间主要不良心血管事件（major adverse cardiovascular events, MACEs）发生的相关性。方法回顾性分析2022年4月至2023年4月首都医科大学附属北京同仁医院心血管中心收治的245例STEMI患者，根据是否发生院内MACEs分为MACEs组（n=48）和Non-MACEs组（n=197）。比较两组患者的临床特征及炎性因子水平，采用多因素Logistic回归分析评估MACEs的独立影响因素，并通过受试者工作特征（receiver operating characteristic, ROC）曲线评估炎性因子的预测效能。结果与Non-MACEs组相比，MACEs组患者的白细胞介素-1β（interleukin-1β，IL-1β）［2.44 (0.21, 7.11) vs 0.35 (0.00, 4.17)，P<0.01］、IL-2［4.09 (1.99, 13.58) vs 1.29 (0.71, 2.09)，P<0.01］、IL-6［55.06 (13.27, 119.28) vs 18.86 (8.81, 37.10)，P<0.01］及IL-8［6.90 (2.32, 15.05) vs 1.74 (0.15, 6.27)，P<0.01）］水平均显著升高。多因素分析显示，IL-2（OR=1.218，95%CI：1.104~1.344，P<0.001）和IL-6（OR=1.003，95%CI：1.000~1.006，P=0.026）是院内MACEs的独立预测因子，左心室射血分数（left ventricular ejection fraction,LVEF）、血钾水平及肌酸激酶同工酶MB型（creatine kinase-myocardial band，CK-MB）亦与MACEs风险显著相关（均P<0.05）。ROC曲线分析表明，IL-2联合临床特征的曲线下面积（area under the curve，AUC）为0.890（95%CI：0.840~0.940, P<0.001），IL-6联合临床特征的ROC为0.833（95%CI：0.766~0.900, P<0.001），均表现出良好的预测效能。结论 STEMI患者在院期间MACEs的发生与IL-2、IL-6水平升高显著相关，同时受血钾水平、LVEF及CK-MB影响。IL-2或IL-6联合临床特征可有效预测MACEs发生风险，为早期风险分层提供重要参考。

关键词: 炎性因子, 急性ST段抬高型心肌梗死, 白细胞介素, 不良心血管事件, 预后, 生物标志物

Abstract: Objective To investigate the associated between the inflammatory cytokine levels and occurrence of major adverse cardiovascular events (MACEs) in hospitalized patients with ST-segment elevation myocardial infarction (STEMI).Methods A retrospective analysis was conducted on 245 STEMI patients admitted to the Cardiovascular Center of Beijing Tongren Hospital, Capital Medical University, between April 2022 and April 2023. Patients were divided into the MACEs group (n=48) and the Non-MACEs group (n=197) based on whether they experienced in-hospital MACEs. Clinical characteristics and inflammatory cytokine levels were compared between the two groups. Multivariable logistic regression analysis was performed to identify independent risk factors for MACEs, and the predictive value of inflammatory cytokines was evaluated with receiver operating characteristic (ROC) curve analysis.Results Compared with the Non-MACEs group, the MACEs group showed significantly higher levels of IL-1β ［2.44 （0.21, 7.11） vs 0.35 （0.00, 4.17）, P<0.01］, IL-2 ［4.09 （1.99, 13.58） vs 1.29 （0.71, 2.09）, P<0.01］, IL-6 ［55.06 （13.27, 119.28） vs 18.86 （8.81, 37.10）, P<0.01］, and IL-8 ［6.90 （2.32, 15.05） vs 1.74 （0.15, 6.27）, P<0.01］. Multivariable analysis revealed that IL-2 (OR=1.218, 95% CI: 1.104－1.344, P<0.001) and IL-6 (OR=1.003, 95% CI: 1.000－1.006, P=0.026) were independent predictive factors for in-hospital MACEs. Additionally, left ventricular ejection fraction (LVEF), serum potassium levels, and CK-MB were significantly associated with MACEs risk (all P<0.05). ROC curve analysis demonstrated that IL-2 combined with clinical features had an area under the ROC curve (AUROC) of 0.890 (95% CI: 0.840–0.940, P<0.001), while IL-6 combined with clinical features had an AUROC of 0.833 (95% CI: 0.766－0.900, P<0.001), both indicating good predictive performance.Conclusion The occurrence of in-hospital MACEs in STEMI patients is significantly associated with elevated levels of IL-2 and IL-6, along with the influence of serum potassium levels, LVEF, and CK-MB. The combination of IL-2 and IL-6 with clinical characteristics can effectively predict the risk of MACEs, providing an important reference for early risk stratification.

Key words: inflammatory cytokines, acute ST-segment elevation myocardial infarction, interleukin, adverse cardiovascular events, prognosis, biomarkers

中图分类号:

R542.2

吴箴言, 江雪, 郭新颖, 张洁, 刘建, 郭彩霞. 急性ST段抬高型心肌梗死患者炎性因子水平与不良心血管事件发生的关系[J]. 首都医科大学学报, 2025, 46(6): 1055-1064.

Wu Zhenyan, Jiang Xue, Guo Xinying, Zhang Jie, Liu Jian, Guo Caixia. The association between the inflammatory cytokine levels and occurrence of adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction[J]. Journal of Capital Medical University, 2025, 46(6): 1055-1064.

参考文献

［1］国家心血管病中心, 中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2023概要［J］. 中国循环杂志, 2024, 39(7): 625－660.
［2］Zeng G Y, Zhang C, Song Y, et al. The potential impact of inflammation on the lipid paradox in patients with acute myocardial infarction: a multicenter study［J］. BMC Med, 2024, 22(1): 599.
［3］Gragnano F, Spirito A, Corpataux N, et al. Impact of clinical presentation on bleeding risk after percutaneous coronary intervention and implications for the ARC-HBR definition［J］. EuroIntervention, 2021, 17(11): e898-e909.
［4］Ong S B, Hernández-Reséndiz S, Crespo-Avilan G E, et al. Inflammation following acute myocardial infarction: multiple players, dynamic roles, and novel therapeutic opportunities［J］. Pharmacol Ther, 2018, 186: 73－87.
［5］Kany S, Vollrath J T, Relja B. Cytokines in inflammatory disease［J］. Int J Mol Sci, 2019, 20(23): 6008.
［6］Frangogiannis N G. The inflammatory response in myocardial injury, repair, and remodelling［J］. Nat Rev Cardiol, 2014, 11(5): 255－265.
［7］Zhang J, Xu H C, Yao M Y, et al. The abnormal level and prognostic potency of multiple inflammatory cytokines in PCI-treated STEMI patients［J］. J Clin Lab Anal, 2022, 36(11): e24730.
［8］Kristono G A, Holley A S, Hally K E, et al. An IL-6-IL-8 score derived from principal component analysis is predictive of adverse outcome in acute myocardial infarction［J］. Cytokine X, 2020, 2(4): 100037.
［9］Yang Y, Li X, Chen G, et al. Traditional Chinese medicine compound (tongxinluo) and clinical outcomes of patients with acute myocardial infarction: The CTS-AMI randomized clinical trial［J］. JAMA, 2023, 330(16): 1534.
［10］Olejarz W, Łacheta D, Kubiak-Tomaszewska G. Matrix metalloproteinases as biomarkers of atherosclerotic plaque instability［J］. Int J Mol Sci, 2020, 21(11): 3946.
［11］Spolski R, Li P, Leonard W J. Biology and regulation of IL-2: from molecular mechanisms to human therapy［J］. Nat Rev Immunol, 2018, 18(10): 648－659.
［12］Pan K M, Xu C Q, Chen C, et al. Soluble interleukin-2 receptor combined with interleukin-8 is a powerful predictor of future adverse cardiovascular events in patients with acute myocardial infarction［J］. Front Cardiovasc Med, 2023, 10: 1110742.
［13］Olsson A G, Schwartz G G, Jonasson L, et al. Are early clinical effects of cholesterol lowering mediated through effects on inflammation?［J］. Acta Physiol Scand, 2002, 176(2): 147－150.
［14］Zheng Y, Li Y Q, Ran X W, et al. Mettl14 mediates the inflammatory response of macrophages in atherosclerosis through the NF-κB/IL-6 signaling pathway［J］. Cell Mol Life Sci, 2022, 79(6): 311.
［15］Niculet E, Chioncel V, Elisei A M, et al. Multifactorial expression of IL-6 with update on COVID-19 and the therapeutic strategies of its blockade (review)［J］. Exp Ther Med, 2021, 21(3): 263.
［16］Moriya J. Critical roles of inflammation in atherosclerosis［J］. J Cardiol, 2019, 73(1): 22－27.
［17］Clare J, Ganly J, Bursill C A, et al. The mechanisms of restenosis and relevance to next generation stent design［J］. Biomolecules, 2022, 12(3): 430.
［18］Sun J L, Yu H, Liu H N, et al. Correlation of pre-operative circulating inflammatory cytokines with restenosis and rapid angiographic stenotic progression risk in coronary artery disease patients underwent percutaneous coronary intervention with drug-eluting stents［J］. J Clin Lab Anal, 2020, 34(3): e23108.
［19］Hofbauer T M, Mangold A, Scherz T, et al. Neutrophil extracellular traps and fibrocytes in ST-segment elevation myocardial infarction［J］. Basic Res Cardiol, 2019, 114(5): 33.
［20］Rached F, Lhomme M, Camont L, et al. Defective functionality of small, dense HDL3 subpopulations in ST segment elevation myocardial infarction: relevance of enrichment in lysophosphatidylcholine, phosphatidic acid and serum amyloid A［J］. Biochim Biophys Acta, 2015, 1851(9): 1254－1261.
［21］Kaptoge S, Seshasai S R K, Gao P, et al. Inflammatory cytokines and risk of coronary heart disease: new prospective study and updated meta-analysis［J］. Eur Heart J, 2014, 35(9): 578－589.
［22］Tøllefsen I M, Shetelig C, Seljeflot I, et al. High levels of interleukin-6 are associated with final infarct size and adverse clinical events in patients with STEMI［J］. Open Heart, 2021, 8(2): e001869.
［23］Butt N, Bache-Mathiesen L K, Ushakova A, et al. Pentraxin 3 in primary percutaneous coronary intervention for ST elevation myocardial infarction is associated with early irreversible myocardial damage: kinetic profile, relationship to interleukin 6 and infarct size［J］. Eur Heart J Acute Cardiovasc Care, 2020, 9(4): 302－312.
［24］Alsmairat Y, Elkholy M, Kidess G G, et al. Impact of rhabdomyolysis on clinical outcomes in patients with acute myocardial infarction［J］. Cureus, 2025, 17(7): e87142.
［25］Podrid P J. Potassium and ventricular arrhythmias［J］. Am J Cardiol, 1990, 65(10): 33E-44E, discussion 52E.
［26］Damman K, Navis G, Smilde T D J, et al. Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction［J］. Eur J Heart Fail, 2007, 9(9): 872－878.
［27］Zhou Y, Chen Y, Liang S Y, et al. Association between potassium fluctuation and in-hospital mortality in acute myocardial infarction patients: a retrospective analysis of the MIMIC-IV database［J/OL］. Clin Res Cardiol, 2025: (2025－02－12)［2025-07-12］. https://pubmed.ncbi.nlm.nih.gov/39939529/.
［28］Grodzinsky A, Goyal A, Gosch K, et al. Prevalence and prognosis of hyperkalemia in patients with acute myocardial infarction［J］. Am J Med, 2016, 129(8): 858－865.
［29］Huang L Y, Zhang J, Huang Q, et al. In-hospital major adverse cardiovascular events after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a retrospective study under the China chest pain center (standard center) treatment system［J］. BMC Cardiovasc Disord, 2023, 23(1): 198.
［30］Janjani P, Motevaseli S, Salehi N, et al. Predictors of 1-year major cardiovascular events after ST-elevation myocardial infarction in a specialized cardiovascular center in western Iran［J］. J Tehran Heart Cent, 2022, 17(2): 62－70.
［31］Dohi T, Maehara A, Brener S J, et al. Utility of peak creatine kinase-MB measurements in predicting myocardial infarct size, left ventricular dysfunction, and outcome after first anterior wall acute myocardial infarction (from the INFUSE-AMI trial)［J］. Am J Cardiol, 2015, 115(5): 563－570.
［32］Separham A, Ghaffari S, Najafi H,et al. The impact of allopurinol on patients with acute ST elevation myocardial infarction undergoing thrombolytic therapy［J］. J Cardiovasc Pharmacol,2016,68(4):265-268.
［33］Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)［J］. Eur Heart J, 2018, 39(2): 119－177.
［34］Ma W K, Li X N, Gao C J, et al. Predictive value of cardiac magnetic resonance for left ventricular remodeling of patients with acute anterior myocardial infarction［J］. Diagnostics, 2022, 12(11): 2780.
［35］Kato K, Yokoyama H, Iwasaki T, et al. Impact of triglyceride levels on the long-term clinical outcomes in patients with acute myocardial infarction［J］. In Vivo, 2024, 38(6): 3078－3084.
［36］Yildiz M, Miedema M D, Murthy A, et al. Association of triglyceride levels with adverse cardiovascular events in patients with ST-segment elevation myocardial infarction［J］. Heliyon, 2023, 9(6): e17308.

[1]	陈璐, 江雪, 郭新颖, 刘建, 郭彩霞. 急性心肌梗死并发心包积液的危险因素及预后影响[J]. 首都医科大学学报, 2025, 46(6): 1033-1043.
[2]	申学谦, 江雪, 郭彩霞. sRAGE在心血管疾病中的生物标志物潜力和调控机制[J]. 首都医科大学学报, 2025, 46(6): 1082-1092.
[3]	孙雪娇, 刘彦茹, 王志仁. CD4⁺和CD8⁺T细胞及线粒体质量与抑郁症的相关性[J]. 首都医科大学学报, 2025, 46(6): 1118-1125.
[4]	李鑫, 姜文剑, 韩杰, 张宏家. 二尖瓣修复术治疗风湿性二尖瓣病变患者的临床效果及影响患者预后的因素[J]. 首都医科大学学报, 2025, 46(5): 885-891.
[5]	郭宇, 陈伟观, 周三连, 汤莉巧, 孙王妍, 张冬梅, 卢红建. 急性缺血性脑卒中患者血清糖蛋白非转移性黑色素瘤蛋白B蛋白浓度与疾病严重度及预后的相关性分析[J]. 首都医科大学学报, 2025, 46(4): 702-709.
[6]	毛文苹, 韩倩, 焦风伟, 王晶, 黄克武. 不同炎性反应标志物预测慢性阻塞性肺疾病病情加重患者预后的比较[J]. 首都医科大学学报, 2025, 46(4): 718-723.
[7]	简焕玲, 戴梓, 岑肖丽, 陈慧玲, 刘志文, 赵颖. 血清尿酸与高密度脂蛋白胆固醇比值与女性不孕的关系[J]. 首都医科大学学报, 2025, 46(2): 348-355.
[8]	翁克霞, 李冰. 活化的白细胞黏附分子在狼疮性肾炎中的研究进展[J]. 首都医科大学学报, 2025, 46(1): 150-153.
[9]	杨芳远, 彭诗洁, 刘婧, 杨金奎, 朱晓蓉. 应用蛋白质组学探索2型糖尿病增殖期视网膜病变潜在生物标志物[J]. 首都医科大学学报, 2024, 45(3): 385-391.
[10]	刘亘梁, 于震维, 冯涛. 早发型帕金森病患者红细胞α-突触核蛋白水平及临床意义研究[J]. 首都医科大学学报, 2023, 44(5): 782-787.
[11]	于建宇, 郑义, 李文斌. 海马钙素类1在原发性中枢神经系统淋巴瘤中表达和临床预后的生物信息学分析[J]. 首都医科大学学报, 2023, 44(5): 724-732.

急性ST段抬高型心肌梗死患者炎性因子水平与不良心血管事件发生的关系

The association between the inflammatory cytokine levels and occurrence of adverse cardiovascular events in patients with acute ST-segment elevation myocardial infarction

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 11

编辑推荐

Metrics

本文评价