炎症因子在老年急性冠脉综合征中的作用

目的 探讨血清可溶性E-选择素(solubility E solectin,sEsel)、可溶性血管细胞粘附分子(solubility vascular cell adhesion molecule,sVCAM-1)和超敏C反应蛋白(hish sensitivity C reactive protein,hs-CRP)浓度在老年急性冠脉综合征(acute coronary syndrome,ACS)发病中的作用.方法 选择老年ACS患者共70例为研究对象,其中不稳定型心绞痛(unstable angina,UA)及非ST段抬高性心急梗死(non ST segment elevated myocardial infarction,NSTEMI)组40例,ST段抬高性心肌梗死(ST segment elevated myocardial infarction,STEMI)组30例,另外选择健康体检者36例为对照组.采用酶联免疫吸附测定(ELISA)法检测血清sEsel和sVCAM-1浓度,采用胶乳免疫比浊法检测hs-CRP.结果 NSTEMI/UA组和STEMI组的血清sEsel、sVCAM-1和hs-CRP浓度均明显高于对照组,STEMI组高于NSTEMI/UA组,而NSTEMI和UA亚组间血清sEsel、sVCAM-1和hs-CRP浓度差异无统计学意义(P>0.05).结论 老年ACS发生时具有明显的炎症反应,炎症因子sEsel、sVCAM-1及hs-CRP在老年ACS的发生中起到重要作用.     

Interrelation between arterial inflammation in acute coronary syndrome and circadian variation

At present, the study into inflammatory markers has become a new tool which is most useful for establishing the prognosis of patients with acute coronary syndrome. The inflammatory substrate involved is acute coronary syndrome is extremely complex, with a large number of factors involved both in its activation and its modulation. It is known that C-reactive protein play a key role in the physiopathology of the atherosclerosis. Furthermore, scientific literature reports that the existence of a circadian rhythm in the triggering of cardiovascular accidents can suggest the implication of, or association with these physiological rhythms that show activity peaks at particular times of the day or night. Keeping in mind the potential association between inflammation and circadian rhythm, a better understanding of the kinetics of said markers could lead to improvements in their use in cardiovascular diseases. Considering the diversity of the diurnal variations in the intrinsic properties of the cardiovascular system, these should be kept in mind during the design of in vivo experimental studies. As such, the information available reinforces our opinion when suitably validating the biomarkers and the need to demonstrate their reliability, stability, and lack of variability and standardise the methodology of their measurement.     

Homocysteine and markers of inflammation in acute coronary syndrome

BACKGROUND:

An elevated level of homocysteine (Hcy) has been shown to be a cardiovascular risk factor in the majority of research studies. Recently, it was found to be associated with new risk factors such as inflammatory markers.

OBJECTIVES:

To investigate the distribution of plasma total Hcy (tHcy) and the levels of inflammatory markers in patients with acute coronary syndrome (ACS), and to evaluate the association between these parameters and the severity of the disease.

METHODS:

A total of 122 patients with ACS and 80 control subjects were recruited from the cardiac intensive care unit of the Military Hospital of Tunis, Tunisia. Lipid profile and the levels of tHcy, high-sensitivity C-reactive protein (HsCRP), interleukin (IL)-6, IL-8, IL-1β and tumour necrosis factor-alpha (TNFα) were determined for all participants. The distribution of these parameters were compared between groups and according to the number of diseased vessels in patients with ACS.

RESULTS:

ACS patients had significantly elevated levels of tHcy (P<0.01), HsCRP (P<0.001), IL-6 (P<0.001), TNFα (P<0.001), folates (P<0.05) and vitamin B₁₂ (P<0.001), but lower high-density lipoprotein cholesterol (P<0.05) levels. The analysis of the association between these parameters and the number of diseased vessels showed significant differences in tHcy, HsCRP, IL-6 and TNFα, with positive correlations. Significantly negative correlations were found between the number of diseased vessels and folate (r=−0.34; P<0.01), and vitamin B₁₂ (r=−0.22; P<0.01).

CONCLUSION:

Elevated levels of tHcy, IL-6, TNFα and HsCRP appear to be associated with a greater number of diseased arteries and, consequently, the severity of coronary artery disease.     

The role of inflammation and infection in acute coronary syndrome

INFLAMMATORY PROCESS: Within the vessel wall is considered to be crucial for initiation and progression of atherosclerosis. As response to endothelial injury a focal inflammatory response arises which can lead to plaque vulnerability and rupture and a consecutive acute coronary syndrome. Systemic markers of inflammation like C-reactive protein (CRP) or interleukin (IL) 6 are elevated in stable angina and acute coronary syndrome and are associated with future cardiovascular events even in initially healthy people. Alongside classical risk factors infectious agents like cytomegalovirus or Chlamydia pneumoniae are discussed to be involved in the local and systemic inflammatory response. Seroepidemiological studies revealed disparate results of the association between antibody titers against Chlamydia pneumoniae or cytomegalovirus and prevalence of coronary artery disease or future cardiovascular events. In animal models Chlamydia pneumoniae and cytomegalovirus increase accelerated neointimal response, however, molecular mechanisms are not entirely clear. CONCLUSION: Whereas local and systemic inflammatory processes play a crucial role in atherogenesis and prognosis the causal role of infection in atherogenesis remains controversial.     

急性冠脉综合征患者炎症标志物水平及其临床意义

目的探讨炎症标志物与急性冠脉综合征（ACS）的关系及临床意义。方法ELISA测定22例急性心肌梗死（AM I）、37例不稳定型心绞痛（UAP）患者及对照组30例外周血可溶性血管间内皮细胞黏附分子（vascu lar celladhesion molecu le-1,sVCAM-1）和血管性假性血友病因子（von W illebrand Factor,vWF）浓度,所有患者均行冠状动脉造影,记录血管病变情况。结果血清sVCAM-1浓度在AM I组明显高于UAP组及对照组（P<0.01）,UAP组明显高于对照组（P<0.01）;血浆vWF浓度在AM I组与UAP组均显著高于对照组（P<0.01）,但AM I组与UAP组比较无统计学意义;血清sVCAM-1与受累冠状动脉血管支数成正相关,r=0.450,P<0.01。而vWF水平与受累冠状动脉血管支数无相关关系,r=0.074。结论血清sVCAM-1与冠状动脉病变程度密切相关,vWF与ACS的发生发展相关联。     

Recurrent stent thrombosis in a patient with acute coronary syndrome and ischemic colitis: between life-threatening thrombosis and life-threatening bleeding

Abstract

Complete blood count should always be considered to tailor diagnosis and appropriate management in patients with acute ischemic heart disease. We present a challenging case of recurrent acute coronary syndrome, in the context of very high thrombotic risk due to concomitant inflammatory disease. Although no general guidelines exist for the switch between antiplatelet agents, particularly in the acute setting, in specific cases, the availability of different orally- and i.v.-acting agents and platelet function tests may allow to discriminate among multiple possible mechanisms of drug failure or side effects in the individual patient.     

高敏C反应蛋白与急性冠脉综合征的相关性

目的：探讨高敏C反应蛋白（hsCRP）与急性冠脉综合征（ACS）病变严重程度及预后之间的关系。方法：选择95例ACS患者,其中急性心肌梗塞（AMI）50例、不稳定型心绞痛（UAP）45例,并根据冠脉病变程度分单支血管病变（SVL）组48例和多支血管病变（MVL）组47例。另选40例非ACS患者作为非ACS对照组,测定各组hsCRP、纤维蛋白原、血脂等指标,进行比较。结果：与非ACS对照组比较,UAP组、AMI组hsCRP水平明显升高[（0.85±0.49）mg/L比（10.01±1.73）mg/L比（52.73±2.39）mg/L,P〈0.01],AMI组明显高于UAP组（P〈0.01）;MVL组hsCRP水平明显高于SVL组[（69.11±1.98）mg/L比（10.12±2.01）mg/L,P〈0.05]。Spearman相关分析显示,hsCRP与冠脉狭窄呈正相关（r=0.210,P=0.042）,与纤维蛋白原（r=0.516,P〈0.0001）、血脂水平呈明显正相关（r=0.100～0.159,P〈0.001～〈0.0001）。结论：高敏C反应蛋白与冠脉病变严重程度呈正相关,是冠心病的独立危险因素;测定高敏C反应蛋白水平对急性冠脉综合征的危险分层和预测病变严重程度具有较高的临床参考价值。     

急性冠状动脉综合征与血尿酸的相关性研究

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)与血尿酸的关系及ACS患者血尿酸升高的相关危险因素。方法选择ACS患者306例,根据诊断分为急性心肌梗死(acute myocardial infarction,AMI)组150例,不稳定性心绞痛(unstable angina pectoris,UAP)组156例。又根据血尿酸水平分为:A组(血尿酸<260.0μmol/L)102例、B组(血尿酸260.0～356.9μmol/L)127例、C组(血尿酸>356.9μmol/L)77例,另选择健康体检者160例作为对照组。观察各组年龄、性别、吸烟史、饮酒史、高血压史、脂肪肝情况、LVEF、血肌酐、尿素、TG、TC、HDL-C、LDL-C、糖化血红蛋白,采用logistic回归分析血尿酸升高的主要因素。结果 AMI组和UAP组血尿酸水平明显高于对照组,差异有统计学意义(P<0.05)。A组、B组、C组在性别、脂肪肝、LVEF、血肌酐和TG等方面差异有统计学意义(P<0.05)。logistic回归分析显示,尿素、血肌酐、TG是ACS患者血尿酸升高的危险因素。结论 ACS患者具有较高的高尿酸发生率,且尿素、血尿酸、TG水平升高可能为ACS患者发生高尿酸血症的重要原因。     

JAK2 mutation and acute coronary syndrome complicated with stent thrombosis

Acute coronary syndrome (ACS) could be a precious opportunity for patients to reveal concealed diseases other than conventional risk factors for ACS, such as hypertension, dyslipidemia, diabetes mellitus, etc. In the setting of ACS, the intracoronary and systemic prothrombotic environment has led to an increase in the risk of stent thrombosis of which mortality was higher among patients with ACS, especially with the highest mortality in patients with ST elevation myocardial infarction. The some specific conditions which were concealed beyond the cardiovascular pathophysiology except well-known risk factors for ACS and stent thrombosis might involve the onset of ACS. We describe a case of a 64-year-old man who was admitted to intensive care unit for chest pain. This case found the possibility that polycythemia vera with Janus kinase 2 (JAK2) V617F mutation might be a underlying disease of ACS with stent thrombosis, and highlighted the importance of recognizing polycythemia vera with JAK2 V617F mutation as concealed disease for cardiologists. We would like to report and review the relationship between ACS and polycythemia vera with JAK2 V617F mutation.     

老年急性冠脉综合征患者药物洗脱支架内亚急性血栓原因分析

目的分析老年急性冠脉综合征（ACS）患者在经皮冠状动脉介入（PCI）治疗后药物洗脱支架内发生亚急性血栓的原因。方法本研究所自2004年1月至2008年1月在行PCI治疗的464例老年ACs患者,记录发生亚急性血栓形成患者的一般情况、冠脉病变特点、PCI治疗情况及抗血小板药物治疗情况,分析其发生亚急性血栓形成的原因。结果在连续464例接受药物洗脱支架治疗的老年ACS患者中,有3例患者（0．65％）在PCI治疗后1周内发生了经冠脉造影证实的支架内亚急性血栓。分析其主要相关因素有：靶病变钙化、病变复杂、多支架植入、无高压后扩张、无血管内超声或光学相干断层成像指导,这些因素的共同特征是都可以导致支架贴壁不良。3例患者中有2例在急诊PCI时死亡,1例经急诊PCI治疗后康复出院。结论老年ACS患者行PCI治疗后发生亚急性血栓的原因可能主要与术中支架的贴壁不良密切相关。     

Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease

Chronic kidney disease is a worldwide growing problem in public health. It is a risk factor for complications in patients with acute coronary syndrome (ACS). Diabetes, hypertension (hypertrophy and left ventricular failure), impaired fibrinolysis and coagulation processes, as well as the rapid development of atherosclerosis (partly associated with chronic inflammation) are responsible for higher prevalence of cardiovascular diseases in patients with chronic kidney disease. Inflammatory process of unknown aetiology belongs to the so-called non-traditional risk factors in development of cardiovascular system diseases. It is thought that this process is responsible for adverse remodelling of atherosclerosis plaque and its instability which causes plaque rupture and as a result a coronary syndrome occurrence. Important inflammatory mediators, which take part in pathogenesis of ACS, are acute phase proteins such as: C-reactive protein, adhesion molecules VCAM-1, ICAM-1, selectins, plasma amyloid A, metalloproteinases, interleukins-1 and -6, tumour necrosis factor-a and vascular endothelial growth factor.     

D-二聚体定量检测对判定急性冠脉综合征血栓形成的研究

目的：探讨D-二聚体定量检测对于判定急性冠脉综合征（ACS）血栓形成的意义。方法：选择住院不稳定型心绞痛（UAP）患者36例,急性心肌梗塞（AMI）患者13例,稳定型心绞痛（SAP）患者23例,采用胶体金标法动态检测患者静脉血中的D-二聚体含量。结果：D-二聚体含量：UAP组（0．95±0．32）mg／L,AMI组（1．82±0．63）mg／L,UAP组与SAP组（0．39±0．15）mg／L比较有显著差异（P〈0．05）,AMI组与SAP组比较,差异非常显著（P〈0．01）。结论：D-二聚体定量检测是判定ACS血栓形成相对特异的敏感指标。     

血红蛋白含量与急性冠状动脉综合征的相关性研究

目的 :探讨冠心病患者外周血红蛋白含量 (Hb)与急性冠状动脉综合征 (ACS)的相关性。方法 :应用美国库尔特JT血球计数器测定Hb含量 ,结合冠状动脉造影 (冠脉造影 )及超声心动图检查 ,观察 2 86例冠心病患者Hb含量及其与冠状动脉硬化及ACS的相关性。结果 :冠心病患者外周血中Hb含量较正常对照组显著增加 (P <0 0 5 ) ,其中ACS组 (急性心肌梗死及不稳定型心绞痛 )Hb含量较正常对照组增加更明显。四分位法研究ACS组Hb含量位于最高 1 4位者较最低 1 4位者显著增加 (P <0 0 5 )。ACS组Hb含量位于最高 1 4位者较稳定型心绞痛 (SAP)组显著增加 (P <0 0 5 )。Hb含量位于最高 1 4位者发生ACS者较Hb含量位于最低 1 4位者显著增加 (P <0 0 5 )。冠状动脉造影显示ACS组冠状动脉狭窄≥ 95 %及冠状动脉闭塞病变的发生率显著高于SAP组 ,冠状动脉闭塞组其Hb含量 (15 0 92± 12 80 )g L显著高于无冠状动脉闭塞组 (139 98± 13 11)g L(P <0 0 5 )。结论 :ACS患者中血红蛋白含量较高。     

CXCL16与急性冠脉综合征的相关性分析

目的探讨急性冠脉综合征（ACS）患者血清CXCL16的表达水平及其与基质金属蛋白酶-2（MMP-2）的关系。方法用ELISA法检测ACS患者,包括不稳定型心绞痛（UAP）40例、急性心肌梗死（AMI）40例及对照组20例患者的血清CXCL16和MMP-2水平并作比较,同时分析血清CXCL16与血清MMP-2的相关关系。结果与对照组相比,UAP组和AMI组CXCL16均显著升高,差异有统计学意义（均P〈0．01）;与UAP组相比,AMI组CXCL16显著升高,且差异有统计学意义（P〈0．05）。与对照组相比,UAP组和AMI组MMP-2均显著升高,差异有统计学意义（均P〈0．01）;与UAP组相比,AMI组MMP-2显著升高,且差异有统计学意义（P〈0．01）。血清CXCL16与MMP-2存在显著线性相关关系（r=0．622,P〈0．01）。结论血清CXCL16是ACS一个独立的生物学指标,并可以作为评价动脉粥样硬化斑块稳定性的指标．