中华老年心脑血管病杂志

目的 探讨白细胞介素（interleukin,IL）-17/IL-23对老年冠心病心力衰竭患者心室重构及预后的影响。方法 前瞻性选择2021年5月至2024年5月南阳市第一人民医院心血管内一科就诊并行经皮冠状动脉介入治疗的老年冠心病心力衰竭患者120例（研究组），研究组又根据随访12个月内存活情况分为不良组21例和良好组99例。另选择同期我院老年健康体检者100例为对照组。测定左心室后壁厚度（left ventricular posterior wall thickness,LVPWT）、左心室舒张末期内径（left ventricular end-diastolic diameter,LVEDD）、左心室射血分数（left ventricular ejection fraction,LVEF）心室重构指标。采用Pearson相关性分析血清IL-17、IL-23表达与心室重构指标的相关性，采用logistic回归分析影响老年冠心病心力衰竭患者预后的因素。采用ROC曲线分析血清IL-17、IL-23表达对老年冠心病心力衰竭患者预后的预测价值。结果 研究组IL-17、IL-23、LVPWT、LVEDD明显高于对照组，LVEF明显低于对照组，差异有统计学意义（P<0.01）。Pearson相关性分析显示，老年冠心病心力衰竭患者IL-17与LVPWT、LVEDD呈正相关（r=0.415,r=0.380,P<0.01），与LVEF呈负相关（r=-0.392,P<0.01）。不良组LVEF明显低于良好组，IL-17、IL-23明显高于良好组，差异有统计学意义（P<0.01）。血清IL-17、IL-23表达升高是老年冠心病心力衰竭患者预后不良的危险因素（P<0.05）。ROC曲线分析显示，IL-17、IL-23联合预测老年冠心病心力衰竭患者预后的曲线下面积明显优于单独预测（0.961 vs 0.813、0.887,P<0.01）。结论 血清IL-17、IL-23表达与老年冠心病心力衰竭患者经皮冠状动脉介入治疗后心室重构和预后有关，并且血清IL-17、IL-23对老年冠心病心力衰竭患者经皮冠状动脉介入治疗后的预后有一定预测价值。

Objective To explore the impact of IL-17/IL-23 on ventricular remodeling and prognosis in elderly coronary heart disease(CHD) patients with heart failure(HF). Methods A total of 120 elderly patients with concomitant CHD and HF undergoing PCI in Nanyang First People's Hospital from May 2021 to May 2024 were recruited and served as the study group. They were further divided into a poor prognosis group(21 cases) and a good prognosis group(99 cases) based on their survival status during the 12-month follow-up. Another 100 elderly healthy individuals who taking physical exams in the same hospital during the same period were enrolled and taken as a control group. Ventricular remodeling indicators, including left ventricular posterior wall thickness(LVPWT), left ventricular end-diastolic diameter(LVEDD), and left ventricular ejection fraction(LVEF), were measured. Pearson correlation analysis was used to determine the correlation between serum IL-17 and IL-23 levels and ventricular remodeling indicators. Logistic regression analysis was conducted to identify factors influencing the prognosis of the elderly CHD patients with HF. ROC curve analysis was performed to evaluate the predictive value of serum IL-17 and IL-23 expression for the prognosis of the elderly patients. Results Significantly higher IL-17 levels, elevated LVPWT and LVEDD values, and lower LVEF value were observed in the study group than the control group(P<0.01). Pearson correlation analysis showed that IL-17 was positively correlated with LVPWT and LVEDD values(r=0.415, r=0.380, P<0.01), and both the two indicators were negatively correlated with LVEF(r=-0.392, P<0.01). The poor prognosis group had significantly lower LVEF and higher IL-17 and IL-23 levels than the good prognosis group(P<0.01). Elevated serum IL-17 and IL-23 levels were risk factors for poor prognosis in the elderly CHD patients with HF(P<0.05). ROC curve analysis showed that the AUC value of combined IL-17 and IL-23 was significantly higher than the AUC value of the indicator alone in predicting the prognosis of the elderly patients(0.961 vs 0.813, 0.887, P < 0.01). Conclusion The serum expression of IL-17 and IL-23 in the IL-17/IL-23 axis is associated with ventricular remodeling and prognosis in the elderly CHD patients with HF after PCI, and the two indicators have certain predictive value for the prognosis of these patients.