作者：许梦阅，王洪如

单位：

330000 江西省南昌市，中国人民解放军联勤保障部队第九〇八医院心血管内科 通信作者：王洪如，E-mail：wanghongru94@163.com

Units：

Department of Cardiology, 908th Hospital of PLA Joint Logistic Support Force, Nanchang 330000, China Corresponding author: WANG Hongru, E-mail: wanghongru94@163.com

关键词：

ST段抬高型心肌梗死; 经皮冠状动脉介入术; 预后; 白介素18; 单核细胞趋化因子1;

Keywords：

ST-segment elevation myocardial infarction; Percutaneous coronary intervention; Prognosis; Interleukin18; Monocyte chemoattractant protein-1

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.077

Funds：

摘要：

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者血清白介素18(IL-18)、单核细胞趋化因子1(MCP-1)水平及其与预后的关系。方法 选取2020年1月至2021年6月中国人民解放军联勤保障部队第九〇八医院收治的315例急性STEMI患者。采用自行设计的基线资料调查表收集患者的基线资料，包括一般资料及实验室检查指标。根据PCI后1个月患者主要不良心血管事件（MACE）发生情况，将其分为预后不良组（发生MACE）和预后良好组（未发生MACE）。采用多因素Logistic回归分析探讨急性STEMI患者预后的影响因素。采用ROC曲线、决策曲线评估血清IL-18、MCP-1水平及其联合预测急性STEMI患者不良预后的价值。结果 PCI后随访1个月，315例急性STEMI患者中有87例预后不良，占27.6%。预后不良组血清IL-18、MCP-1、N末端脑钠肽前体（NT-proBNP）、肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I(cTnI)水平高于预后良好组（P<0.05）。多因素Logistic回归分析结果显示，血清IL-18、MCP-1、NT-proBNP、CK-MB水平是急性STEMI患者预后的影响因素（P<0.05）。ROC曲线分析结果显示，血清IL-18、MCP-1水平及其联合预测急性STEMI患者不良预后的AUC分别为0.812、0.770、0.840。决策曲线分析结果显示，阈值概率为0.37～0.80、0.83～0.95时，血清IL-18、MCP-1水平联合预测急性STEMI患者不良预后的净获益率优于单纯血清IL-18、MCP-1水平。结论 急性STEMI患者血清IL-18、MCP-1水平升高，其与患者不良预后有关，对不良预后有一定预测价值，且二者联合预测的净获益率更高。

Abstract：

【Abstract】　Objective To investigate the levels of serum interleukin-18 (IL-18) and monocyte chemoattractantprotein-1 (MCP-1) in patients with acute ST-segment elevation myocardial infarction (STEMI) and their relationship withprognosis. Methods A total of 315 patients with acute STEMI treated in 908th Hospital of PLA Joint Logistic Support Force fromJanuary 2020 to June 2021 were selected. A self-designed baseline data questionnaire was used to collect the patients' baselinedata, including general data and laboratory test indicators. According to the occurrence of major adverse cardiovascular events(MACE) 1 month after PCI, patients were divided into the poor prognosis group (with MACE) and the good prognosis group (withoutMACE) . Multivariate Logistic regression analysis was used to explore the influencing factors of the prognosis of patients with acuteSTEMI. The value of serum IL-18 and MCP-1 levels and their combination in predicting poor prognosis in patients with acuteSTEMI was evaluated by ROC curve and decision curve. Results One month after PCI, 87 of 315 patients with acute STEMIhad poor prognosis, accounting for 27.6%. The levels of serum IL-18, MCP-1, N-terminal pro-brain natriuretic peptide (NTproBNP) , creatine kinase isoenzyme (CK-MB) , cardiac troponin I (cTnI) of the poor prognosis group were higher than those of thegood prognosis group ( P < 0.05) . Multivariate Logistic regression analysis results showed that the levels of serum IL-18, MCP-1, NT-proBNP and CK-MB were influencing factors of prognosis in patients with acute STEMI ( P < 0.05) . ROC curve analysisresults showed that the AUC of serum IL-18, MCP-1 levels and their combination for predicting poor prognosis in patients withacute STEMI were 0.812, 0.770, and 0.840, respectively. The decision curve analysis results showed that, in the threshold range of0.37-0.80 and 0.83-0.95, the net benefit rate of combining IL-18 and MCP-1 levels in predicting poor prognosis of patients withacute STEMI was better than that of serum IL-18 or MCP-1 level alone. Conclusion The levels of serum IL-18 and MCP-1 areelevated and related to the poor prognosis in patients with acute STEMI, they have high predictive value for poor prognosis, andthe combined prediction has a higher net benefit rate.

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