慢性炎症是胰腺手术患者围手术期心肌损伤或心力衰竭的危险因素吗？

BJA open Pub Date : 2025-05-19 DOI:10.1016/j.bjao.2025.100417

Ted Reniers , Thijs Rettig , Laura van Zeggeren , Ineke Dijkstra , Kyra Prinsze , Izaak Molenaar , Hjalmar van Santvoort , Olaf Cremer , Lisette Vernooij , Peter Noordzij

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引用次数: 0

摘要

背景：慢性炎症与心血管疾病有关。患有慢性炎症的手术患者是否会增加心脏风险尚不清楚。我们假设术前白细胞介素6 （IL-6）与术后指示心肌损伤和心力衰竭的生物标志物释放有关。方法在本前瞻性队列研究中，胰腺手术患者术前及术后4、12、24、48 h检测IL-6、高敏心肌肌钙蛋白-t （hs-cTnT）、生长分化因子15 （GDF-15）、n端前b型利钠肽（NT-proBNP）浓度。主要终点是围手术期心肌损伤（PMI），定义为hs-cTnT绝对升高≥14 pg ml−1。次要结局是术后GDF-15和NT-proBNP的浓度。我们使用χ2检验和广义线性混合效应模型进行分析。结果88例患者中，24例（27%）术前IL-6较高（7 pg ml - 1）。2例（8.3%）出现PMI， 8例（12.5%）出现PMI （P=0.86）。IL-6高的患者术前hs-cTnT（11.0[四分位数间距7.0-15.0]vs 8.0 [5.0-11.0] pg ml -1， P=0.01）、GDF-15 （1924.5 [1403.8-2797.5] vs 1445.0 pg ml -1 [1006.5-1905.3] pg ml -1， P=0.021）和NT-proBNP （279.5 [128.8-569.0] vs 116.5 [65.1-226.5] pg ml -1， P=0.012）浓度较高。术后所有生物标志物均升高（p < 0.05），但术前IL-6浓度高或正常患者的升高相似。结论术前炎症与胰腺手术后PMI或术后心力衰竭生物标志物无关。然而，IL-6浓度高的患者术前心脏生物标志物浓度较高，提示存在亚临床心血管疾病。临床试验注册号nct03460938。

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Is chronic inflammation a risk factor for perioperative myocardial injury or heart failure in pancreatic surgery patients?

Background

Chronic inflammation is associated with cardiovascular disease. Whether cardiac risk is increased in surgical patients with chronic inflammation is unknown. We hypothesised that preoperative interleukin 6 (IL-6) is associated with postoperative biomarker release indicative of myocardial injury and heart failure.

Methods

In this prospective cohort study in pancreatic surgery patients, concentrations of IL-6, high-sensitive cardiac troponin-T (hs-cTnT), growth differentiation factor 15 (GDF-15), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were assessed before surgery and 4, 12, 24, and 48 h after surgery. The primary outcome was perioperative myocardial injury (PMI), defined as an absolute hs-cTnT increase ≥14 pg ml⁻¹. Secondary outcomes were postoperative concentrations of GDF-15 and NT-proBNP. We used the χ² test and generalised linear mixed effects models for analyses.

Results

Of 88 patients, 24 (27%) had high preoperative IL-6 (>7 pg ml⁻¹). PMI occurred in two (8.3%) and eight (12.5%) patients with high and normal concentrations, respectively (P=0.86). Patients with high IL-6 had higher preoperative concentrations of hs-cTnT (11.0 [inter-quartile range 7.0–15.0] vs 8.0 [5.0–11.0] pg ml⁻¹, P=0.01), GDF-15 (1924.5 [1403.8–2797.5] vs 1445.0 pg ml⁻¹ [1006.5–1905.3] pg ml⁻¹, P=0.021) and NT-proBNP (279.5 [128.8–569.0] vs 116.5 [65.1–226.5] pg ml⁻¹, P=0.012). All biomarkers increased after surgery (all P<0.05), yet this increase was similar among patients with high or normal preoperative IL-6 concentrations.

Conclusions

Preoperative inflammation was not associated with PMI or postoperative biomarkers of heart failure after pancreatic surgery. However, patients with high IL-6 concentrations had higher preoperative concentrations of cardiac biomarkers, suggesting the presence of subclinical cardiovascular disease.