Segev Amit, Strauss Bradley H, Witztum Joseph L, Lau Herbert K, Tsimikas Sotirios
Ann and Roy Foss Interventional Research Program, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Am Heart J. 2005 Nov;150(5):1007-14. doi: 10.1016/j.ahj.2004.12.008.
This study was performed to assess the relationship between oxidized low-density lipoprotein (OxLDL) and restenosis. OxLDL induces up-regulation of inflammatory genes and cytokines and recruits monocytes to the vessel wall. Elevated levels of monocytes post-percutaneous coronary intervention (PCI) are associated with in-stent restenosis.
One hundred forty-one patients with stable angina pectoris had serial blood samples drawn before PCI (68% balloon only, 32% stent), immediately post-PCI and at 6 and 24 hours, 3 days, 1 week, and 1, 3, and 6 months. Plasma levels of OxLDL-E06, a measure of oxidized phospholipid (OxPL) content on apoB-100 detected by antibody E06 (OxPL/apoB), autoantibodies to malondialdehyde-LDL and copper-oxidized LDL, and apoB-immune complexes were measured in all samples. Quantitative and qualitative coronary angiography was performed with 94% angiographic follow-up. Restenosis was defined as >50% diameter stenosis (%DS). The overall angiographic restenosis rate was 32% (39% in balloon group, 16% in stent group). OxPL/apoB levels rose significantly and OxLDL autoantibody titers decreased immediately post-PCI in patients both with and without restenosis, but there were no significant differences among groups. There was also no relationship of any OxLDL marker to lesion length, %DS, or minimal lumen diameter. No differences were noted in stent versus balloon-treated patients.
Serial measurement of a comprehensive panel of circulating OxLDL markers after uncomplicated PCI for stable angina does not predict restenosis.
本研究旨在评估氧化型低密度脂蛋白（OxLDL）与再狭窄之间的关系。OxLDL可诱导炎症基因和细胞因子上调，并促使单核细胞募集至血管壁。经皮冠状动脉介入治疗（PCI）后单核细胞水平升高与支架内再狭窄相关。
141例稳定型心绞痛患者在PCI术前（68%仅行球囊扩张，32%植入支架）、PCI术后即刻、术后6小时、24小时、3天、1周、1个月、3个月和6个月采集系列血样。检测所有样本中OxLDL-E06（一种通过抗体E06检测的载脂蛋白B-100上氧化磷脂（OxPL）含量的指标（OxPL/apoB））、丙二醛-LDL和铜氧化LDL自身抗体以及载脂蛋白B免疫复合物的血浆水平。94%的患者进行了定量和定性冠状动脉造影随访。再狭窄定义为直径狭窄>50%（%DS）。总体造影再狭窄率为32%（球囊组为39%，支架组为16%）。无论有无再狭窄，患者PCI术后即刻OxPL/apoB水平显著升高，OxLDL自身抗体滴度降低，但组间无显著差异。任何OxLDL标志物与病变长度、%DS或最小管腔直径均无关联。支架治疗与球囊扩张治疗患者之间无差异。
对于稳定型心绞痛患者，在进行无并发症的PCI术后，对一系列循环OxLDL标志物进行连续测量并不能预测再狭窄。
