Hartford Marianne, Wiklund Olof, Mattsson Hultén Lillemor, Perers Elisabeth, Person Anita, Herlitz Johan, Hurt-Camejo Eva, Karlsson Thomas, Caidahl Kenneth
Department of Cardiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
Int J Cardiol. 2006 Mar 22;108(1):55-62. doi: 10.1016/j.ijcard.2005.04.004.
The objectives of this study were to examine the time course of the inflammatory response in acute coronary syndromes (ACS) and to assess the markers of inflammation and their relation to disease severity.
We prospectively studied 134 patients with ACS who survived for at least 30 months. The patients were divided into four groups: acute myocardial infarction (MI) with (n=54) or without (n=46) ST-segment elevation and unstable angina with (n=14) or without (n=20) increased risk. Plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A2 group IIA (sPLA2-IIA), and intercellular adhesion molecule-1 (ICAM-1) were measured on days 1 and 4 and after 3 and 30 months.
The highest levels of CRP and sPLA2-IIA were seen on day 4 but for IL-6 on day 1. These three markers, but not ICAM-1, were significantly related to disease severity, CKMB, and ejection fraction. Patients in Killip class II-IV had higher levels than those in Killip class I. The individual acute-phase responses correlated with marker levels at 3 and 30 months. ICAM-1 correlated with the development of congestive heart failure.
In ACS there seems to be an individual predisposition to inflammatory response. Plasma IL-6 is the first marker to rise, while sPLA2-IIA and CRP peak later. All three markers, especially CRP, may discriminate between MI and non-MI. ICAM-1 seems to reflect other aspects of the inflammatory processes than the other markers. The results emphasize the complexity of the inflammatory response in ACS and stress the need for further studies involving multiple markers.
本研究的目的是检查急性冠状动脉综合征（ACS）中炎症反应的时间进程，并评估炎症标志物及其与疾病严重程度的关系。
我们前瞻性地研究了134例存活至少30个月的ACS患者。患者分为四组：伴有（n = 54）或不伴有（n = 46）ST段抬高的急性心肌梗死（MI）以及伴有（n = 14）或不伴有（n = 20）风险增加的不稳定型心绞痛。在第1天、第4天以及3个月和30个月后测量血浆C反应蛋白（CRP）、白细胞介素-6（IL-6）、分泌型磷脂酶A2 IIA组（sPLA2-IIA）和细胞间黏附分子-1（ICAM-1）的水平。
CRP和sPLA2-IIA的最高水平出现在第4天，而IL-6的最高水平出现在第1天。这三种标志物，而非ICAM-1，与疾病严重程度、肌酸激酶同工酶（CKMB）和射血分数显著相关。Killip分级II-IV级的患者水平高于Killip分级I级的患者。个体急性期反应与3个月和30个月时的标志物水平相关。ICAM-1与充血性心力衰竭的发生相关。
在ACS中似乎存在个体对炎症反应的易感性。血浆IL-6是第一个升高的标志物，而sPLA2-IIA和CRP随后达到峰值。所有这三种标志物，尤其是CRP，可能有助于区分MI和非MI。ICAM-1似乎反映了炎症过程的其他方面，与其他标志物不同。结果强调了ACS中炎症反应的复杂性，并强调了进一步研究多种标志物的必要性。
