Itoh Teruhiko, Mizuno Yuji, Harada Eisaku, Yoshimura Michihiro, Ogawa Hisao, Yasue Hirofumi
Division of Cardiology, Kumamoto Kinou Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan.
Circ J. 2007 Jul;71(7):1074-8. doi: 10.1253/circj.71.1074.
Coronary spasm plays an important role in the pathogenesis of ischemic heart disease and it may be associated with low-grade inflammation.
Intracoronary injection of acetylcholine was done in 199 patients (99 men, 100 women, mean age, 64.5+/-11.0 years) with chest pain and normal coronary angiograms. According to the results of the provocation test, the study subjects were divided into 2 groups: the spasm group of 112 patients and the non-spasm group of 87 patients. Clinical data including high-sensitivity C-reactive protein (hs-CRP) and other coronary risk factors were compared between the 2 groups. Serum levels of hs-CRP were significantly higher in the spasm group than in the non-spasm group (median: 1.2 mg/L vs 0.5 mg/L, p<0.005). Multivariate analysis showed that hs-CRP and smoking history were independently associated with coronary spasm with an odds ratio of 2.28 (p=0.027) and 2.25 (p=0.037), respectively, with a hs-CRP value of > or = 2 mg/L as cutoff point.
Minor elevations of the serum hs-CRP level are significantly associated with coronary spasm, suggesting that chronic low-grade inflammation may be involved in the pathogenesis of coronary spasm.
冠状动脉痉挛在缺血性心脏病的发病机制中起重要作用，且可能与低度炎症相关。
对199例（99例男性，100例女性，平均年龄64.5±11.0岁）有胸痛且冠状动脉造影正常的患者进行冠状动脉内注射乙酰胆碱。根据激发试验结果，将研究对象分为两组：痉挛组112例患者和非痉挛组87例患者。比较两组间包括高敏C反应蛋白（hs-CRP）及其他冠状动脉危险因素在内的临床资料。痉挛组血清hs-CRP水平显著高于非痉挛组（中位数：1.2 mg/L对0.5 mg/L，p<0.005）。多因素分析显示，hs-CRP和吸烟史与冠状动脉痉挛独立相关，比值比分别为2.28（p=0.027）和2.25（p=0.037），以hs-CRP值≥2 mg/L为截断点。
血清hs-CRP水平轻度升高与冠状动脉痉挛显著相关，提示慢性低度炎症可能参与冠状动脉痉挛的发病机制。
