Quilici Jacques, Banzet Nathalie, Paule Philippe, Meynard Jean-Baptiste, Mutin Murielle, Bonnet Jean-Louis, Ambrosi Pierre, Sampol José, Dignat-George Françoise
Département de Cardiologie, Hôpital Timone Adultes, Marseille, France.
Circulation. 2004 Sep 21;110(12):1586-91. doi: 10.1161/01.CIR.0000142295.85740.98. Epub 2004 Sep 13.
Shedding of endothelial cells from damaged endothelium into the blood occurs in a variety of vascular disorders. The purpose of this study was to evaluate the utility of circulating endothelial cell (CEC) count as a diagnostic marker of non-ST-elevation acute coronary syndromes (ACSs).
CEC counts were determined immediately (H0), 4 hours (H4), and 8 hours (H8) after admission in 60 patients with documented non-ST-elevation ACS and 40 control patients with no evidence of coronary artery disease. A total of 32 patients in the ACS group had elevated CEC counts (>3 cells/mL) in relation to early admission and single-episode chest pain. Patients from the control group had normal CEC counts. The interval between the chest pain episode and elevation was significantly shorter for CEC than troponin I. No correlation was found between the 2 markers. Interestingly, a subgroup of ACS patients with initially normal troponin I levels had high CEC counts, thus allowing early diagnosis in 30% more cases. At H0, the mean area under the receiver operating characteristic curve was significantly higher with the CEC count than with the troponin I level. At H4 and H8, the combined use of CEC and troponin was significantly better as a marker of ACS than CEC alone or troponin I alone.
This study demonstrates that CEC count can be used as an early, specific, independent diagnostic marker for non-ST-elevation ACS. A combined strategy using CEC count and troponin I level could provide an effective diagnostic tool.
在各种血管疾病中，受损内皮的内皮细胞会脱落进入血液。本研究的目的是评估循环内皮细胞（CEC）计数作为非ST段抬高型急性冠状动脉综合征（ACS）诊断标志物的效用。
对60例确诊为非ST段抬高型ACS的患者和40例无冠状动脉疾病证据的对照患者在入院后即刻（H0）、4小时（H4）和8小时（H8）测定CEC计数。ACS组中共有32例患者相对于早期入院和单次发作胸痛而言CEC计数升高（>3个细胞/毫升）。对照组患者的CEC计数正常。CEC计数升高与胸痛发作之间的间隔明显短于肌钙蛋白I。未发现这两种标志物之间存在相关性。有趣的是，一组初始肌钙蛋白I水平正常的ACS患者CEC计数较高，从而使更多病例（多30%）能够得到早期诊断。在H0时，CEC计数的受试者工作特征曲线下平均面积显著高于肌钙蛋白I水平。在H4和H8时，联合使用CEC和肌钙蛋白作为ACS标志物比单独使用CEC或单独使用肌钙蛋白I要好得多。
本研究表明，CEC计数可作为非ST段抬高型ACS的早期、特异性、独立诊断标志物。联合使用CEC计数和肌钙蛋白I水平的策略可提供一种有效的诊断工具。
