Krupinski Jerzy, Catena Esther, Miguel Marta, Domenech Pere, Vila Ramon, Morchon Sergio, Rubio Francisco, Cairols Marc, Slevin Mark, Badimon Lina
Cardiovascular Research Center, IIBB/CSIC-HSCSP-UAB, Barcelona, Spain.
Int J Cardiol. 2007 Mar 20;116(2):174-9. doi: 10.1016/j.ijcard.2006.02.014. Epub 2006 Aug 8.
Although atherosclerosis is a silent widespread disease, the focal character of the lesions triggering the clinical manifestations is unquestionable. We hypothesized that symptomatic patients with advanced, unstable carotid plaques have increased local intraplaque and circulating levels of fibrin-fibrinogen related products.
Plaque tissue and plasma samples were studied in 106 patients undergoing endarterectomy for symptomatic and asymptomatic carotid disease. Fibrin-fibrinogen related products were evaluated by ELISA, Western-blotting, and histology. All tested parameters were compared with patient carotid symptomatology, multiple vascular risk factors (VRF), bilateral carotid pathology, ultrasound examination, and previous therapies with statins and/or antiplatelet drugs.
In symptomatic patients, plasma D-dimer was elevated in patients with unstable carotid plaques (UNS) compared with stable (STA) ones (857+/-121 vs. 692+/-156 ng/ml, p=0. 026). Furthermore, plasma D-dimer was significantly increased in patients with a coexistence of carotid and coronary artery disease, compared to others (976+/-325 vs. 714+/-197 ng/ml; p<0.001). Intra-plaque D-dimer content was increased in ulcerated-complicated (UC) plaques compared with fibrous non-complicated (F) plaques in symptomatic patients (5.9+/-1 vs. 1.8+/-1, p<0.001), and in patients with hypercholesterolaemia, compared with those with normal cholesterol levels (6.1+/-1 vs. 2.9+/-0.7; p=0.027). However, there was no correlation between D-dimer content in the carotid plaque and plasma D-dimer levels.
Hypercholesterolemia and UC plaques appear to be associated with high fibrin intraplaque turnover as demonstrated by higher intraplaque D-dimer. Plasma markers of fibrin turnover were increased in UNS plaques, and in patients with coexisting carotid and coronary artery disease. Although, both plasma and plaque D-dimers were associated with unstable carotid disease, the usefulness of the measurement of plasma D-dimer in these patients should be confirmed by prospective studies.
尽管动脉粥样硬化是一种隐匿性广泛存在的疾病，但引发临床表现的病变具有局灶性这一点是毋庸置疑的。我们推测，患有晚期不稳定颈动脉斑块的有症状患者，其斑块内局部及循环中的纤维蛋白 - 纤维蛋白原相关产物水平会升高。
对106例因有症状和无症状颈动脉疾病接受内膜切除术的患者的斑块组织和血浆样本进行了研究。通过酶联免疫吸附测定法（ELISA）、蛋白质印迹法和组织学评估纤维蛋白 - 纤维蛋白原相关产物。将所有测试参数与患者的颈动脉症状、多种血管危险因素（VRF）、双侧颈动脉病变情况、超声检查以及先前使用他汀类药物和/或抗血小板药物的治疗情况进行比较。
在有症状的患者中，与稳定（STA）颈动脉斑块患者相比，不稳定（UNS）颈动脉斑块患者的血浆D - 二聚体升高（857±121对692±156 ng/ml，p = 0.026）。此外，与其他患者相比，同时患有颈动脉和冠状动脉疾病的患者血浆D - 二聚体显著升高（976±325对714±197 ng/ml；p<0.001）。在有症状的患者中，与纤维性非复杂（F）斑块相比，溃疡 - 复杂（UC）斑块内的D - 二聚体含量增加（5.9±1对1.8±1，p<0.001），在高胆固醇血症患者中，与胆固醇水平正常的患者相比，斑块内D - 二聚体含量也增加（6.1±1对2.9±0.7；p = 0.027）。然而，颈动脉斑块中的D - 二聚体含量与血浆D - 二聚体水平之间没有相关性。
高胆固醇血症和UC斑块似乎与斑块内纤维蛋白高周转率相关，这可通过较高的斑块内D - 二聚体得以证明。在UNS斑块以及同时患有颈动脉和冠状动脉疾病的患者中，纤维蛋白周转的血浆标志物升高。尽管血浆和斑块D - 二聚体均与不稳定颈动脉疾病相关，但在这些患者中测量血浆D - 二聚体的实用性应通过前瞻性研究加以证实。
