Montes R, Hurtado V, Alonso A, Foco L, Zonzin P, Mannucci P M, Hermida J
Haematology Department and the Division of Cardiovascular Pathophysiology, Laboratory of Thrombosis and Haemostasis, Clínica Universitaria/School of Medicine, Applied Medical Research Centre, Pamplona, Spain.
J Thromb Haemost. 2005 Jul;3(7):1454-8. doi: 10.1111/j.1538-7836.2005.01297.x.
Acute myocardial infarction (AMI) is rare among young women. The search for unknown risk factors is warranted. Endothelial protein C receptor (EPCR) is largely present at the endothelial surface of large arteries. No studies about association of anti-EPCR autoantibodies (anti-EPCR) with AMI are available.
Plasma IgA, IgM and IgG anti-EPCR levels were measured by enzyme-linked immunosorbent assay in 165 women younger than 45 years who survived a first AMI and 165 healthy women, matched by age and geographical origin.
Using the 90th percentile of IgA anti-EPCR in the control group, IgA anti-EPCR were independently associated with AMI after adjustment for cardiovascular risk factors (OR 5.1; 95% CI 1.7-15.6; P = 0.004). The risk apparently conferred by IgA anti-EPCR increased dose-dependently (P for trend =0.0002). IgM anti-EPCR were less consistently associated with AMI: a significant increase in the risk was found when women above the 90th percentile were compared with those in the lowest quartile (OR 3.6; 95% CI 1.2-11.5; P = 0.03). IgG anti-EPCR were similar in patients and controls. A total of 145 patients underwent coronary arteriography. IgA or IgM anti-EPCR were not different among patients with different degrees of atherosclerotic lesion (anova, P = 0.77 and 0.24, respectively).
High levels of IgA and, to a lesser extent, IgM anti-EPCR, are associated with AMI in young women.
急性心肌梗死（AMI）在年轻女性中较为罕见。有必要寻找未知的风险因素。内皮蛋白C受体（EPCR）主要存在于大动脉的内皮表面。目前尚无关于抗EPCR自身抗体（抗EPCR）与AMI相关性的研究。
采用酶联免疫吸附测定法，检测了165例年龄小于45岁且首次发生AMI存活的女性患者以及165例年龄和地理来源相匹配的健康女性的血浆IgA、IgM和IgG抗EPCR水平。
以对照组IgA抗EPCR的第90百分位数为界，在校正心血管危险因素后，IgA抗EPCR与AMI独立相关（OR 5.1；95%CI 1.7 - 15.6；P = 0.004）。IgA抗EPCR所带来的风险呈剂量依赖性增加（趋势P = 0.0002）。IgM抗EPCR与AMI的相关性不太一致：第90百分位数以上的女性与最低四分位数的女性相比，风险显著增加（OR 3.6；95%CI 1.2 - 11.5；P = 0.03）。患者和对照组的IgG抗EPCR水平相似。共有145例患者接受了冠状动脉造影。不同程度动脉粥样硬化病变患者的IgA或IgM抗EPCR水平无差异（方差分析，P分别为0.77和0.24）。
高水平的IgA以及程度较轻的IgM抗EPCR与年轻女性的AMI相关。
