Alber Hannes F, Duftner Christina, Wanitschek Maria, Dörler Jakob, Schirmer Michael, Suessenbacher Alois, Frick Matthias, Dichtl Wolfgang, Pachinger Otmar, Weidinger Franz
Division of Cardiology, Innsbruck Medical University, Austria.
Int J Cardiol. 2009 Jun 12;135(1):27-35. doi: 10.1016/j.ijcard.2008.03.010. Epub 2008 Jun 30.
Macrophages and pro-inflammatory CD3+CD4+CD28- T lymphocytes are involved in atherosclerotic plaque destabilization. Whether neopterin, a macrophage-specific activation-marker, and circulating CD3+CD4+CD28- cells are also related to the severity and extent of coronary artery disease (CAD) in stable patients is still unclear.
Coronary angiograms of 30 patients with stable angina pectoris were graded using the Gensini severity and an extent score. Patients were grouped according to the median of each score. Lymphocyte subsets were determined by FACS analysis and neopterin by radioimmunoassay. Peripheral endothelial function of the brachial artery (FMD) shown to correlate with cardiovascular risk factors was evaluated using high-resolution ultrasound.
More extensive CAD was associated with increased neopterin levels (8.3 +/- 3.3 vs. 5.5 +/- 1.2 nmol/L, p < 0.001) and increased CD3+CD4+CD28- cells (3.1 +/- 1.6 vs. 2.0 +/- 1.2%, p < 0.05). A high Gensini severity score was associated with increased neopterin levels (7.8 +/- 2.7 vs. 6.3 +/- 1.7 nmol/L, p < 0.05), but not with CD3+CD4+CD28- cells. Neopterin correlated with both the extent (r = 0.59, p < 0.001) and the Gensini score (r = 0.57, p < 0.003). FMD was not correlated with both scores.
Neopterin and CD3+CD4+CD28- lymphocytes are associated with CAD extent in stable patients, thereby emphasizing the inherent role of inflammation in atherogenesis itself beyond plaque destabilization. Neopterin's correlation with CAD severity might be additionally useful in identifying patients eligible for revascularization procedures.
巨噬细胞和促炎性CD3⁺CD4⁺CD28⁻ T淋巴细胞参与动脉粥样硬化斑块的不稳定过程。尚不清楚巨噬细胞特异性激活标志物新蝶呤以及循环CD3⁺CD4⁺CD28⁻细胞是否也与稳定型患者冠状动脉疾病（CAD）的严重程度和范围相关。
采用Gensini严重程度评分和范围评分对30例稳定型心绞痛患者的冠状动脉造影进行分级。根据每个评分的中位数对患者进行分组。通过流式细胞术分析确定淋巴细胞亚群，通过放射免疫测定法测定新蝶呤。使用高分辨率超声评估显示与心血管危险因素相关的肱动脉外周内皮功能（FMD）。
更广泛的CAD与新蝶呤水平升高（8.3±3.3对5.5±1.2 nmol/L，p<0.001）和CD3⁺CD4⁺CD28⁻细胞增加（3.1±1.6对2.0±1.2%，p<0.05）相关。高Gensini严重程度评分与新蝶呤水平升高相关（7.8±2.7对6.3±1.7 nmol/L，p<0.05），但与CD3⁺CD4⁺CD28⁻细胞无关。新蝶呤与范围（r = 0.59，p<0.001）和Gensini评分（r = 0.57，p<0.003）均相关。FMD与两个评分均无关。
新蝶呤和CD3⁺CD4⁺CD28⁻淋巴细胞与稳定型患者的CAD范围相关，从而强调了炎症在动脉粥样硬化发生过程中本身的内在作用，而不仅仅是斑块不稳定。新蝶呤与CAD严重程度的相关性可能在识别适合血管重建手术的患者方面具有额外的用途。
