Gökçe Mustafa, Erdöl Cevdet, Orem Cihan, Tekelioglu Yavuz, Durmuş Ismet, Kasap Hasan
Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey.
Jpn Heart J. 2002 Nov;43(6):593-605. doi: 10.1536/jhj.43.593.
The aim of this study was to assess the relations between inflammation, immune response, and coronary angiographic findings in patients with unstable angina pectoris (UAP). Recent studies suggest a role for inflammation in the pathophysiology of UAP. Although activation of neutrophils, monocytes and lymphocytes has been shown in UAP, no studies have correlated the activation findings with clinical and angiographic features of patients with UAP. Seventy-three patients undergoing coronary angiography were classified according to their ischaemic syndrome, stable angina pectoris (SAP) (n = 25) and UAP (n = 48). Patients with UAP were classified using the Braunwald classification; UAP class I (n = 15), UAP class II (n = 15), and UAP class III (n = 18). Patients with UAP were also classified into a progression to myocardial infarction (MI (+)) group (n = 15) and a non-progression to myocardial infarction (MI(-)) group (n = 33). Venous blood samples were taken from all patients. Cell surface receptors (CD4, CD8, CD3, CD14, CD45, CD56+16, and HLA-DR) were detected by flow cytometry using monoclonal antibodies tagged with fluorescent markers and serum levels of C-reactive protein (CRP) were measured. The serum levels of CRP and the percentages of HLA-DR, CD14, and CD16+56 were higher in UAP than SAP. The serum levels of CRP and percentages of HLA-DR, CD14, and CD16+56 were higher in UAP class II than UAP class I. The serum levels of CRP and percentages of HLA-DR, CD14, and CD16+56 were higher in UAP class III than UAP class II and UAP class I. The serum levels of CRP and percentages of CD16+56 were higher in the MI(+) group than the MI(-) group. The CRP levels in serum and the percentages of cell surface antigens had no correlation with extent of coronary artery disease (no differences among one, two or three vessels) but Type C lesion had significantly higher percentages of HLA-DR, CD14, CD16+56 and the serum levels of CRP than Type A and Type B lesions. This investigation shows that inflammatory and immunologial components may be detectable in UAP and were correlated with the clinical severity, progression to myocardial infarction, and lesion morphology, but were not correlated with the extent of coronary artery disease.
本研究旨在评估不稳定型心绞痛（UAP）患者炎症、免疫反应与冠状动脉造影结果之间的关系。近期研究表明炎症在UAP的病理生理学中发挥作用。虽然已证实在UAP中存在中性粒细胞、单核细胞和淋巴细胞的激活，但尚无研究将这些激活结果与UAP患者的临床及血管造影特征相关联。73例行冠状动脉造影的患者根据其缺血综合征分为稳定型心绞痛（SAP）组（n = 25）和UAP组（n = 48）。UAP患者采用Braunwald分类法进行分类；UAP I级（n = 15）、UAP II级（n = 15）和UAP III级（n = 18）。UAP患者还被分为进展为心肌梗死（MI（+））组（n = 15）和未进展为心肌梗死（MI（-））组（n = 33）。采集所有患者的静脉血样本。使用标记有荧光标记的单克隆抗体通过流式细胞术检测细胞表面受体（CD4、CD8、CD3、CD14、CD45、CD56 + 16和HLA - DR），并测量血清C反应蛋白（CRP）水平。UAP患者的CRP血清水平以及HLA - DR、CD14和CD16 + 56的百分比高于SAP患者。UAP II级患者的CRP血清水平以及HLA - DR、CD14和CD16 + 56的百分比高于UAP I级患者。UAP III级患者的CRP血清水平以及HLA - DR、CD14和CD16 + 56的百分比高于UAP II级和UAP I级患者。MI（+）组的CRP血清水平以及CD16 + 56的百分比高于MI（-）组。血清中的CRP水平和细胞表面抗原的百分比与冠状动脉疾病的范围无关（单支、双支或三支血管病变之间无差异），但C型病变的HLA - DR、CD14、CD16 + 56百分比及CRP血清水平显著高于A型和B型病变。本研究表明，在UAP中可检测到炎症和免疫成分，且这些成分与临床严重程度、进展为心肌梗死以及病变形态相关，但与冠状动脉疾病的范围无关。
