炎症标志物与急性冠状动脉综合征

动脉粥样硬化性疾病是一种慢性、非特异性、炎性疾病。在动脉粥样硬化性疾病的不同临床表现过程中,炎症与其发生和发展的所有阶段有关。急性冠状动脉综合征是冠心病的特殊疾病谱,新近研究证实,炎症在急性冠状动脉综合征患者的粥样斑块破裂与血栓形成中起主要作用。炎症与易损斑块的形成有关;临床试验证据支持炎症在急性冠状动脉综合征发生中的病因学地位;炎症标志物的使用,也提供了一个了解急性冠状动脉综合征病理生理机制的窗口。因此,急性冠状动脉综合征可以认为是一种心血管急性炎症综合征。     

急性冠状动脉综合征与炎症相关的的生化标志物研究进展

局部或全身性炎症在急性冠状动脉综合征 (ACS)中起着重要作用。 C-反应蛋白、粘附分子、CD40 L、细胞因子、金属蛋白酶、核因子 -κB等参与这种炎症反应过程及其调节 ,作为 ACS的炎症标志物 ,在 ACS的临床诊断、治疗及预后具有一定价值。     

炎症与急性冠状动脉综合征的研究进展

自从1999年Ross〔1〕提出动脉粥样硬化(AS)是一种炎症性疾病以后,大量研究证实了这种假设。许多研究〔2,3〕表明,冠状动脉(冠脉)局部或全身的炎症与免疫反应在AS的发生、发展过程及其所致的并发症中起着重要作用,炎症反应的激活可能是导致AS斑块不稳定的主要因素。急性冠脉综合征(ACS)则是由于冠脉内AS斑块不稳定、破裂、血管收缩和局部血栓形成,引起部分或全部血管堵塞,导致的不稳定型心绞痛(UAP)、急性心肌梗死(AMI)或心脏性猝死(SCD)的急性缺血综合征。本文就炎症与ACS的关系的研究进展综述如下。1炎症相关生化指标与ACS ACS…     

血清炎症标志物及与急性冠状动脉综合征关系的研究进展

本文回顾了近 5年来 ,国内外对血清炎症标志物与急性冠状动脉综合征关系的研究状况 ,着重介绍有关C反应蛋白、血清肺炎衣原体和巨细胞病毒与急性冠状动脉综合征相关性的临床研究进展及存在的不足 ,阐述了炎症可能在急性冠状动脉综合征发生、发展及并发症中起作用及可能机制 ,简单总结了目前应用抗生素作为急性冠状动脉综合征的一级和二级预防所做的初期临床试验及在试验中所面临的问题 ,展望了未来研究的方向。     

炎症与急性冠状动脉综合征

冠状动脉不稳定性粥样斑块的破裂、表面破损或裂隙 ,随后继发的血小板聚集和血栓形成 ,引起冠状动脉急性完全或不完全堵塞 ,是导致包括不稳定型心绞痛 (UA)、急性心肌梗塞 (AMI)和心源性猝死的急性冠状动脉综合征 (Acutecoronarysyndromes,ACS)的主要病理机制。不稳定粥样斑块的标志是斑块内脂质丰富、炎症反应活跃、胶原与血管平滑肌细胞少 ,且纤维帽薄 ,容易破裂[1 ] 。目前认为 ,炎症反应在粥样斑块的不稳定性和破裂中起重要作用。因此 ,认识炎症与ACS的关系 ,对预防、诊断和治疗ACS非常重要。1　炎症反应参与急性冠状动脉综合征的…     

炎症因子与急性心肌梗死的研究进展

急性心肌梗死是临床较为常见的心血管疾病之一,是在冠状动脉粥样硬化发生发展基础上,因血栓形成、斑块破裂所致心肌持久性缺血缺氧,造成局部心肌坏死。炎症因子参与冠状动脉粥样硬化斑块的形成和进展,与急性心肌梗死的发生发展存在密切的关系。本文就相关炎症因子在急性心肌梗死中的研究进展进行综述。     

辛伐他汀对正常血脂水平急性冠状动脉综合征患者早期炎症因子的干预观察

目的观察正常血脂水平急性冠状动脉综合征(ACS)患者早期白介素-6(IL-6)和高敏C反应蛋白(hs-CRP)水平变化及辛伐他汀早期治疗对其干预效果。方法将血脂水平正常的 ACS患者随机分为辛代他汀治疗组(20 mg/d×4周)和常规治疗对照组(各40例),另选择同期健康对照者40例作为健康对照组。分析比较组间及两组ACS患者治疗前后血清IL-6和hs-CRP水平变化。结果两组ACS患者血脂水平与健康对照组比较无显著性差别,但其IL-6和hs—CRP水平均显著高于健康对照组(P<0．01);辛伐他汀治疗2周时血脂水平无显著变化,但IL-6和hs—CPP水平显著降低(P<0．01),治疗4周时血清总胆固醇和低密度脂蛋白胆固醇及IL-6、hs-CRP水平均显著降低 (P<0．05,P<0．01)且显著低于常规对照组(P<0．05)。结论血脂水平正常的ACS患者同样存在明显的炎症反应,辛伐他汀具有独立于调脂的抗炎作用,其快速抗炎作用在ACS患者早期治疗中可能具有重要意义。     

核因子-κB、炎症与急性冠状动脉综合征

核因子 -κB可以在转录水平上激活多种与炎症有关的细胞因子、粘附分子的表达 ,成为冠状动脉粥样硬化性心脏病的发病机制之一 ,近来有研究发现核因子 -κB在急性冠状动脉综合征中特异激活 ,作者在分子水平上对动脉粥样斑块破裂的机制作一综述     

炎症因子在急性冠状动脉综合征预后中的作用

为探讨C-反应蛋白、纤维蛋白原和肿瘤坏死因子α等炎症因子在急性冠状动脉综合征患者预后中的作用，连续观察了76例急性冠状动脉综合征患者入院时上述指标的变化，随访7～12个月，记录住院期间和出院后新发生的心血管事件。结果发现，随访期内发生心血管事件者C-反应蛋白和纤维蛋白原浓度高于未发生者，而肿瘤坏死因子α在对照组和急性冠状动脉综合征患者的浓度无差别；多因素Logistic回归分析发现，C-反应蛋白和纤维蛋白原是心血管事件的独立危险因素。表明C-反应蛋白和纤维蛋白原是判断急性冠状动脉综合征患者短期预后的有用指标，肿瘤坏死因子α对判断急性冠状动脉综合征患者的预后无价值。     

急性冠状动脉综合征——不稳定斑块、炎症与急性冠状动脉综合征

急性冠状动脉综合征(ACS)是一组由于冠状动脉斑块破裂致血管严重狭窄或闭塞而发生心肌缺血和(或)局部坏死的综合征，临床表现为不稳定型心绞痛(UAP)、非Q波及Q波心肌梗死(MI)和猝死。近来研究表明，不稳定斑块破裂是导致ACS的主要原因，而炎症与不稳定斑块的发生、发展及破裂有极重要的联系。     

Relationship Between Dobutamine Echocardiography and the Elevation of Cardiac Troponin I in Patients with Acute Coronary Syndromes

An elevated cardiac troponin I (cTnI) and a positive dobutamine echocardiography are powerful predictors for future cardiac events in patients with coronary artery disease. Investigating their correlation also should be helpful in understanding their clinical usefulness in evaluating patients with acute coronary syndromes (ACS). Dobutamine echocardiography and a blood sampling for cTnI were performed on 117 patients with ACS 70 +/- 2 hours after arriving at the hospital. CTnI was considered elevated when its value was greater than 2.0 ng/ml. Dobutamine echocardiography was positive in 86 (73.5%) patients, and cTnI was elevated in 37 (31.6%). The occurrence of positive dobutamine echocardiography in patients with elevated cTnI was significantly higher than in those with normal cTnI (86.5% vs. 67.5%, P = 0.042). More patients in the elevated cTnI group developed myocardial ischemia before or at the stage of dobutamine 20 microg/kg/min (43.2% vs. 15%, P = 0.002). When compared with patients with normal cTnI, patients with elevated cTnI had a lower ischemic threshold during dobutamine echocardiography, and more frequently had baseline echocardiographic wall-motion abnormalities, a history of myocardial infarction, and a positive dobutamine echocardiography. Using multivariate analysis, we found that only a lower dobutamine echocardiography ischemic threshold (P = 0.0008) and baseline wall-motion abnormalities (P = 0.0004) were associated independently with the elevation of cTnI. Our results suggest that in patients with ACS, dobutamine echocardiography can offer information regarding wall-motion abnormalities and ischemic threshold, which are suggested to have a clinical value similar to elevated cTnI.     

Relationship Between Minor Myocardial Damage and Inflammatory Acute-Phase Reaction in Acute Coronary Syndromes

Background: In severe acute coronary syndromes (ACS) elevation of markers of inflammation and acute phase reaction (APR) like C-reactive protein (CRP) as well as a release of troponin have been reported.Using a high sensitivity troponin T (TnT) test we investigated whether an APR occurs in ACS only in the presence of ischemic myocardial damage. Methods: In 85 patients with ACS C-reactive protein (CRP), serum amyloid A (SAA), fibrinogen, thrombin antithrombin III complexes (TAT) and kallikrein were determined vs. high sensitive TnT (0.02 ng/ml) initially and 2 d later vs. 45 patients with stable angina pectoris and 42 controls. Results: In stable angina pectoris, markers of inflammation and coagulation were slightly elevated (p < 0.05). Initially in ACS elevations of CRP to 1.2 ± 0.3 mg/dl, SAA to 4.8 ± 2.6 mg/dl and fibrinogen to 448 ± 21 mg/dl (all p < 0.01 vs. controls) were found followed by a significant APR (p < 0.01).In the subgroup of TnT positive ACS patients, an APR with increased CRP (4.1 ± 1.3 mg/dl), SAA (20.4 ± 8.3 mg/dl), and fibrinogen (641 ± 45 mg/dl) was detectable (all p < 0.05 vs. TnT negative patients). In contrast, patients without TnT release showed APR markers comparable to patients with stable angina pectoris. Conclusion: Our findings demonstrate an association between myocardial injury in ACS and acute phase reaction as evidenced by several molecular markers. A highly sensitive TnT-test identified myocardial inury in about all patients with APR while a standard TnT cut-off (0.1 ng/ml) missed 32% of these patients. Thus, the APR in patients with ACS is strongly associated with at least minor ischemic myocardial damage and prior findings of an APR independent from myocardial injury are probably based on less sensitive troponin tests.     

细胞外基质金属蛋白酶诱导因子与急性冠脉综合征关系的研究进展

细胞外基质金属蛋白酶诱导因子是一种高糖基化的跨膜蛋白,广泛表达于人体的各种组织细胞,属于免疫球蛋白家族。细胞外基质金属蛋白酶诱导因子可通过刺激冠脉动脉粥样斑块内的基质金属蛋白酶的分泌来影响斑块的稳定性,在急性冠脉综合征的发生、发展方面起到了重要作用。现就细胞外基质金属蛋白酶诱导因子在急性冠脉综合征方面的作用作一综述。     

平均血小板体积与急性冠状动脉综合征关系的研究进展

急性冠状动脉综合征是目前严重威胁人类健康的疾病之一,平均血小板体积作为血小板功能和活性标志物,对急性冠状动脉综合征的预测具有一定临床意义,现就其研究现状做一综述。     

Coronary Embolus: An Underappreciated Cause of Acute Coronary Syndromes

Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation. The authors review the historic and contemporary published data about this important cause of acute coronary syndromes. The authors propose an investigation and management strategy for work-up and anticoagulation strategy for patients with suspected coronary embolism.     

管腔狭窄程度与急性心肌梗死

急性心肌梗死是在易损斑块破裂基础上继发血栓形成并堵塞冠状动脉管腔所致。目前普遍认为导致急性心肌梗死的斑块绝大多数表现为轻、中度管腔狭窄,但近两年来此观点愈来愈受到质疑与挑战。现将近几年关于管腔狭窄严重程度与急性心肌梗死关系的研究进展进行综述。     

Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region

Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.     

红细胞膜脂质与急性冠脉综合征斑块易损性的相关性研究

斑块的易损性是急性冠脉综合征主要病理生理机制。而斑块内出血和新生血管的形成在易损斑块的形成中起着重要的作用,这其中红细胞膜脂质可能发挥着巨大的作用,它们通过不同的机制使斑块从稳定发展为不稳定。