Basta Giuseppina, Berti Sergio, Cocci Franca, Lazzerini Guido, Parri Serena, Papa Angela, Battaglia Debora, Lubrano Valter, Del Turco Serena, Ravani Marcello, Rizza Antonio, De Caterina Raffaele, Marraccini Paolo, Mazzone Annamaria
CNR, Institute of Clinical Physiology, Pisa, Massa, Italy.
Coron Artery Dis. 2008 Aug;19(5):299-305. doi: 10.1097/MCA.0b013e3282fec058.
In animal models, increased tissue receptor for advanced glycation end products and its ligands, including N-epsilon-(carboxymethyl)lysine (CML), are critically implicated in postprocedural intimal hyperplasia after balloon injury. In patients undergoing percutaneous coronary interventions with stenting, we investigated whether plasma levels of CML and the soluble form of receptor for advanced glycation end products (sRAGE) changed during poststenting follow-up.
We studied 81 patients with coronary artery disease who underwent successful percutaneous coronary interventions. Plasma levels of CML and sRAGE were measured before intervention, and at 1 day and 180 days of follow-up.
CML levels increased significantly at day 1 after stenting and persisted at an elevated level at 180 days (P=0.013), whereas sRAGE levels increased significantly at 180 days (P=0.011). CML levels were significantly higher in multivessel-treated patients than in single-vessel-treated patients both at 1 day and 180 days of follow-up. In addition, CML values were positively associated with the extent of stent area at 1 day and 180 days of follow-up (r=0.278, P=0.022 and r=0.315, P=0.012, respectively). In logistic regression analysis, only the extent of stent area predicted adverse clinical events at 180-day follow-up (P=0.03, odds ratio=14.25, confidence interval=1.25-162.2).
This study supports the hypothesis that increased circulating levels of CML occurred in the presence of vascular injury. This persistent rise of CML could amplify an inflammatory phenomenon triggered by stent placement and thus contributes to coronary artery disease progression.
在动物模型中，晚期糖基化终产物及其配体（包括N-ε-（羧甲基）赖氨酸（CML））的组织受体增加与球囊损伤后程序性内膜增生密切相关。在接受支架置入的经皮冠状动脉介入治疗的患者中，我们研究了支架置入后随访期间血浆CML水平和晚期糖基化终产物受体的可溶性形式（sRAGE）是否发生变化。
我们研究了81例成功接受经皮冠状动脉介入治疗的冠心病患者。在干预前、随访1天和180天时测量血浆CML和sRAGE水平。
支架置入后第1天CML水平显著升高，并在180天时持续维持在较高水平（P = 0.013），而sRAGE水平在180天时显著升高（P = 0.011）。在随访1天和180天时，多支血管治疗患者的CML水平显著高于单支血管治疗患者。此外，随访1天和180天时，CML值与支架面积大小呈正相关（分别为r = 0.278，P = 0.022和r = 0.315，P = 0.012）。在逻辑回归分析中，只有支架面积大小可预测180天随访时的不良临床事件（P = 0.03，比值比 = 14.25，置信区间 = 1.25 - 162.2）。
本研究支持以下假设，即血管损伤时循环中CML水平会升高。CML的持续升高可能会放大支架置入引发的炎症现象，从而促进冠状动脉疾病的进展。
