Hung Ming-Jui, Cherng Wen-Jin, Cheng Chi-Wen, Li Li-Fu
Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
Am J Cardiol. 2006 May 15;97(10):1429-34. doi: 10.1016/j.amjcard.2005.12.035. Epub 2006 Mar 27.
Serum levels of inflammatory markers (interleukin-6, monocyte chemoattractant protein-1, soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, and C-reactive protein) were measured at baseline in serum samples from 189 patients who were admitted for coronary angiography because of suspected ischemic heart disease. Median duration of follow-up was 28 months. Patients in our sample were enrolled in 4 diagnostic groups: no hemodynamically significant coronary artery disease (CAD) and no coronary vasospasm (control group, n = 32), hemodynamically significant CAD and stable angina pectoris (SAP group, n = 34), coronary vasospastic angina pectoris without hemodynamically significant CAD (vasospasm group, n = 31), and acute coronary syndrome (ACS) and hemodynamically significant CAD (ACS group, n = 92). Overall, the level of serum inflammatory markers was highest in the ACS group and lowest in the control group, with intermediate values observed in the SAP and vasospasm groups, with the exception of soluble intercellular adhesion molecule-1, the level of which was highest in the vasospasm group. Multivariate analysis showed that log (interleukin-6) was independently associated with a diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD (odds ratio 8.48, p = 0.027). Patients in the ACS group had a significantly lower survival rate compared with the other 3 groups but without an independent predictor that could be identified in this patient cohort. Recurrent angina pectoris occurred with similar rates in the SAP, vasospasm, and ACS groups. The independent predictor for recurrent angina pectoris was treatment that did not include clopidogrel (odds ratio 3.88, p = 0.007). In conclusion, the results of this study suggest that inflammation can exist in coronary vasospasm without hemodynamically significant CAD.
对189例因疑似缺血性心脏病入院接受冠状动脉造影的患者，在基线时测定其血清炎症标志物（白细胞介素-6、单核细胞趋化蛋白-1、可溶性细胞间黏附分子-1、可溶性血管黏附分子-1和C反应蛋白）水平。中位随访时间为28个月。我们样本中的患者分为4个诊断组：无血流动力学显著意义的冠状动脉疾病（CAD）且无冠状动脉痉挛（对照组，n = 32）、血流动力学显著意义的CAD且稳定型心绞痛（SAP组，n = 34）、无血流动力学显著意义的CAD的冠状动脉痉挛性心绞痛（痉挛组，n = 31）以及急性冠状动脉综合征（ACS）且血流动力学显著意义的CAD（ACS组，n = 92）。总体而言，血清炎症标志物水平在ACS组最高，在对照组最低，SAP组和痉挛组为中间值，但可溶性细胞间黏附分子-1除外，其水平在痉挛组最高。多变量分析显示，log（白细胞介素-6）与无血流动力学显著意义的CAD患者的冠状动脉痉挛性心绞痛诊断独立相关（比值比8.48，p = 0.027）。ACS组患者的生存率显著低于其他3组，但在该患者队列中未发现可识别的独立预测因素。SAP组、痉挛组和ACS组复发性心绞痛的发生率相似。复发性心绞痛的独立预测因素是未使用氯吡格雷的治疗（比值比3.88，p = 0.007）。总之，本研究结果表明，在无血流动力学显著意义的CAD的冠状动脉痉挛中可能存在炎症。
