Stefanadis Christodoulos, Toutouzas Konstantinos, Tsiamis Eleftherios, Vavuranakis Manolis, Tsioufis Costas, Stefanadi Elli, Boudoulas Harisios
First Department of Cardiology, Athens Medical School, Hippokration Hospital, Athens, Greece.
Atherosclerosis. 2007 Jun;192(2):396-400. doi: 10.1016/j.atherosclerosis.2006.05.038. Epub 2006 Jul 3.
Although previous studies have shown systemic inflammatory activation the relation with the local plaque inflammatory activation has not been extensively studied. The present study investigated the relation between local and systemic inflammatory activation in patients with coronary artery disease and the impact of atorvastatin treatment. We included 215 patients undergoing percutaneous coronary intervention; of them 140 were treated with atorvastatin. Patients with stable angina (SA) and acute coronary syndromes (ACS) were included. Systemic inflammation was assessed by serum C-reactive protein (CRP), soluble adhesion molecules levels and local plaque inflammatory activation by coronary thermography. Temperature difference (DeltaT) was assigned as the difference between the proximal vessel wall temperature from the maximal temperature at the culprit plaque. Patients with ACS (n=78) had increased DeltaT compared to patients with SA (n=137) (0.16+/-0.10 degrees C versus 0.08+/-0.07 degrees C, P<0.001). Patients treated with atorvastatin had lower DeltaT compared to untreated patients (0.10+/-0.07 degrees C versus 0.15+/-0.10 degrees C, P<0.01). DeltaT was less in the treated group compared to the untreated group in patients with SA and ACS (ACS: 0.13+/-0.08 degrees C versus 0.20+/-0.11 degrees C, P<0.01, SA: 0.08+/-0.06 degrees C versus 0.13+/-0.08 degrees C, P=0.03). Although a correlation was found between CRP levels and DeltaT (R=0.29, P<0.01), in certain groups a discrepancy between CRP levels and DeltaT was observed. In 25% of patients with low DeltaT CRP levels were >1mg/dl and in 35.5% of patients with high DeltaT CRP was <2mg/dl. The correlation between soluble adhesion molecules and DeltaT did not reach statistical significance. Although there is a correlation between widespread and local inflammatory activation in patients with coronary artery disease, a discrepancy between culprit plaque and systemic inflammatory activation is observed. Atorvastatin has a parallel effect on systemic and local inflammatory process in patients with coronary artery disease.
尽管先前的研究已显示全身炎症激活，但局部斑块炎症激活与之的关系尚未得到广泛研究。本研究调查了冠心病患者局部和全身炎症激活之间的关系以及阿托伐他汀治疗的影响。我们纳入了215例行经皮冠状动脉介入治疗的患者；其中140例接受了阿托伐他汀治疗。纳入了稳定型心绞痛（SA）和急性冠状动脉综合征（ACS）患者。通过血清C反应蛋白（CRP）、可溶性黏附分子水平评估全身炎症，通过冠状动脉热成像评估局部斑块炎症激活。温度差（ΔT）定义为罪犯斑块处最高温度与近端血管壁温度之差。与SA患者（n = 137）相比，ACS患者（n = 78）的ΔT升高（0.16±0.10℃对0.08±0.07℃，P < 0.001）。与未治疗患者相比，接受阿托伐他汀治疗的患者ΔT更低（0.10±0.07℃对0.15±0.10℃，P < 0.01）。在SA和ACS患者中，治疗组的ΔT低于未治疗组（ACS：0.13±0.08℃对0.20±0.11℃，P < 0.01；SA：0.08±0.06℃对0.13±0.08℃，P = 0.03）。尽管发现CRP水平与ΔT之间存在相关性（R = 0.29，P < 0.01），但在某些组中观察到CRP水平与ΔT之间存在差异。在25%的低ΔT患者中，CRP水平>1mg/dl，在35.5%的高ΔT患者中，CRP <2mg/dl。可溶性黏附分子与ΔT之间的相关性未达到统计学意义。尽管冠心病患者广泛炎症激活与局部炎症激活之间存在相关性，但观察到罪犯斑块炎症激活与全身炎症激活之间存在差异。阿托伐他汀对冠心病患者的全身和局部炎症过程具有平行作用。
