Niccoli Giampaolo, Biasucci Luigi M, Biscione Carmine, Buffon Antonio, Siviglia Massimo, Conte Micaela, Porto Italo, Graziani Francesca, Liuzzo Giovanna, Crea Filippo
Int J Cardiol. 2007 Nov 30;122(3):245-7. doi: 10.1016/j.ijcard.2006.11.073. Epub 2007 Jan 30.
Mechanisms of instability in patients affected by unstable angina and who exhibit low levels of C-reactive protein (CRP) on admission are unclear. We compared levels of markers of thrombin generation [thrombin-antithrombin complexes (TAT), of fibrinolysis [plasmin-antiplasmin complexes (PAP)], and angiographic severity and extent of coronary atherosclerosis in patients with severe unstable angina and high or low systemic levels of CRP.
Forty consecutive patients (age 59.7+/-8.7, 76% males) admitted to our coronary care unit with severe unstable angina (Braunwald class IIIB) were included in the present study. We assayed TAT and PAP using commercially available ELISA assays and CRP with high sensitivity nephelometry. The evaluation of atherosclerotic disease severity and extent was performed. Patients were divided in two groups according to CRP levels: G1=CRP>3 mg/L and G2=CRP<3 mg/L.
Number of diseased vessels and number of stenoses plus occlusion were similar between the two groups (1.8+/-0.9 in G1 vs 2.2+/-0.9 in G2, p=NS and 2.6+/-1.9 in G1 vs 2.7+/-1.3 in G2, p=NS, respectively), as well as extent score and index (8.4+/-4.5 in G1 vs 9.2+/-3.1 in G2, p=NS and 0.6+/-0.3 in G1 vs 0.6+/-0.27 in G2, p=NS, respectively). Episodic activation of thrombin generation, as assessed by TAT was more frequent in G1 than in G2 (85% vs 47%, p=0.03). Episodic activation of the fibrinolysis was more frequent in G1 than in G2 (80% vs 40%, p=0.01).
Patients with coronary instability and systemic evidence of inflammation exhibit more frequent activation of the thrombin/fibrinolysis system than patients with a similar clinical presentation but no evidence of systemic inflammation, whereas the coronary atherosclerotic burden is similar. The mechanisms of coronary instability in the absence of systemic evidence of inflammation need to be elucidated by future studies.
不稳定型心绞痛患者入院时C反应蛋白（CRP）水平较低，其不稳定机制尚不清楚。我们比较了重度不稳定型心绞痛且全身CRP水平高或低的患者中凝血酶生成标志物[凝血酶 - 抗凝血酶复合物（TAT）]、纤溶标志物[纤溶酶 - 抗纤溶酶复合物（PAP）]的水平，以及冠状动脉粥样硬化的血管造影严重程度和范围。
本研究纳入了连续40例因重度不稳定型心绞痛（Braunwald IIIB级）入住我们冠心病监护病房的患者（年龄59.7±8.7岁，76%为男性）。我们使用市售ELISA检测法检测TAT和PAP，并用高敏比浊法检测CRP。对动脉粥样硬化疾病的严重程度和范围进行评估。根据CRP水平将患者分为两组：G1 = CRP>3 mg/L，G2 = CRP<3 mg/L。
两组间病变血管数量、狭窄加闭塞数量相似（G1组为1.8±0.9，G2组为2.2±0.9，p = 无显著性差异；G1组为2.6±1.9，G2组为2.7±1.3，p = 无显著性差异），范围评分和指数也相似（G1组为8.4±4.5，G2组为9.2±3.1，p = 无显著性差异；G1组为0.6±0.3，G2组为0.6±0.27，p = 无显著性差异）。通过TAT评估，G1组凝血酶生成的间歇性激活比G2组更频繁（85%对47%，p = 0.03）。G1组纤溶的间歇性激活比G2组更频繁（80%对40%，p = 0.01）。
与具有相似临床表现但无全身炎症证据的患者相比，冠状动脉不稳定且有全身炎症证据的患者凝血酶/纤溶系统激活更频繁，而冠状动脉粥样硬化负担相似。未来研究需要阐明无全身炎症证据时冠状动脉不稳定的机制。
