Internal Medicine and Clinical Immunology Laboratory, University Hospital Basel, Petersgraben, Basel, Switzerland.
Eur Heart J. 2010 May;31(10):1181-7. doi: 10.1093/eurheartj/ehp597. Epub 2010 Jan 19.
Experimental data point towards a favourable effect of low serum concentrations of complement mannose-binding lectin (MBL) on myocardial ischaemia/reperfusion (I/R) injury. As comparable data on the role of MBL in human I/R injury is lacking, we investigated the influence of low serum MBL concentrations on mortality of patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).
Mannose-binding lectin was determined in 890 acute STEMI patients that were prospectively recruited in the APEX-AMI trial. This trial had a primary endpoint of death through Day 30 and secondary endpoints of death through Day 90 and the composite of death, cardiogenic shock, or congestive heart failure (CHF) through Days 30 and 90. Samples were taken immediately before PCI and the analysis of MBL limited to patients having received placebo. Patients with serum MBL levels of or below 100 ng/mL were considered to be functionally deficient. Of the 890 patients, 127 had functional MBL deficiency (14.3%). Characteristics of patients with MBL deficiency and those with MBL levels >100 ng/mL did not differ. In patients with MBL deficiency, there was 1 death (0.79%) compared with 42 deaths (5.51%) in patients with MBL levels >100 ng/mL (P = 0.0233) representing an absolute and relative lower mortality in MBL deficient patients of 4.7 and 85%, respectively. Functional MBL deficiency, however, was not associated with decreased risk of the combined endpoints of death and shock or death, shock, and CHF, respectively.
Functional deficiency of complement MBL is associated with reduced mortality in patients with STEMI undergoing PCI. This unique finding suggests that a component of the innate immune system affects mortality in STEMI patients undergoing primary PCI.
clinicaltrials.gov, Identifier: NCT00091637.
实验数据表明，低血清补体甘露聚糖结合凝集素（MBL）浓度对心肌缺血/再灌注（I/R）损伤有有利影响。由于缺乏关于 MBL 在人类 I/R 损伤中的作用的可比数据，我们研究了低血清 MBL 浓度对接受直接经皮冠状动脉介入治疗（PCI）的急性 ST 段抬高型心肌梗死（STEMI）患者死亡率的影响。
在 APEX-AMI 试验中前瞻性招募了 890 名急性 STEMI 患者，测定了他们的 MBL。该试验的主要终点是 30 天内死亡，次要终点是 90 天内死亡以及 30 天和 90 天内死亡、心源性休克或充血性心力衰竭（CHF）的复合终点。在 PCI 前立即采集样本，并将 MBL 分析仅限于接受安慰剂的患者。MBL 水平等于或低于 100ng/mL 的患者被认为存在功能缺陷。在 890 名患者中，有 127 名患者存在 MBL 功能缺陷（14.3%）。MBL 缺陷患者与 MBL 水平＞100ng/mL 的患者的特征没有差异。在 MBL 缺陷患者中，有 1 例死亡（0.79%），而 MBL 水平＞100ng/mL 的患者有 42 例死亡（5.51%）（P=0.0233），MBL 缺陷患者的绝对和相对死亡率分别降低了 4.7%和 85%。然而，MBL 功能缺陷与降低死亡和休克的联合终点风险或死亡、休克和 CHF 的风险无关。
补体 MBL 的功能缺陷与接受 PCI 的 STEMI 患者的死亡率降低相关。这一独特的发现表明，固有免疫系统的一个组成部分影响接受直接 PCI 的 STEMI 患者的死亡率。
clinicaltrials.gov，标识符：NCT00091637。
