Candemir Basar, Ertas Fatih Sinan, Kaya Cansin Tulunay, Ozdol Cagdas, Hasan Taner, Akan Ozay Arikan, Sahin Mustafa, Erol Cetin
Department of Cardiology, Ankara University, School of Medicine, Ankara, Turkey.
J Heart Valve Dis. 2010 Nov;19(6):745-52.
Mechanisms leading to vascular and tissue calcification are not yet fully understood. Previously, an association has been demonstrated between a controversial calcifying nanoparticle (CNP; also known as 'nanobacteria') and vascular calcification and kidney stone formation. The study aim was to evaluate a possible association between mitral annular calcification (MAC) and CNP infection.
A total of 93 patients with MAC, detected using echocardiography, and 94 asymptomatic subjects without valvular and coronary artery calcification, were enrolled in the study. The serum levels of anti-CNP-antibodies were monitored in all subjects.
Patients with MAC were generally older and had a higher prevalence of systemic hypertension, diabetes mellitus, and dyslipidemia. The anti-CNP-antibody titers, which were significantly associated with MAC (p < 0.0001), were increased with older age and MAC thickness, but decreased in line with serum levels of HDL-cholesterol (p < 0.0001). In order to provide a cut-off point for anti-CNP-antibodies when detecting MAC, a receiver operating characteristic curve was created. Serum CNP-antibody levels above 0.19 units/ml showed a sensitivity of 73%, a specificity of 72%, and positive and negative predictive values of 72% and 73%, respectively. Multivariate logistic regression analysis revealed that increasing age, systemic hypertension, diabetes, HDL-cholesterol levels and high anti-CNP titers were risk factors that were independently associated with calcification in the mitral annuli.
The study results suggested that CNP might play an important role in the pathogenesis of MAC.
导致血管和组织钙化的机制尚未完全明确。此前，已证实一种有争议的钙化纳米颗粒（CNP；也称为“纳米细菌”）与血管钙化及肾结石形成之间存在关联。本研究旨在评估二尖瓣环钙化（MAC）与CNP感染之间可能存在的关联。
本研究共纳入93例经超声心动图检测发现有MAC的患者以及94例无瓣膜和冠状动脉钙化的无症状受试者。监测所有受试者血清中抗CNP抗体的水平。
患有MAC的患者通常年龄较大，系统性高血压、糖尿病和血脂异常的患病率较高。抗CNP抗体滴度与MAC显著相关（p < 0.0001），随年龄增长和MAC厚度增加而升高，但与高密度脂蛋白胆固醇的血清水平呈负相关（p < 0.0001）。为了确定检测MAC时抗CNP抗体的临界值，绘制了受试者工作特征曲线。血清CNP抗体水平高于0.19单位/毫升时，敏感性为73%，特异性为72%，阳性预测值和阴性预测值分别为72%和73%。多因素逻辑回归分析显示，年龄增长、系统性高血压、糖尿病、高密度脂蛋白胆固醇水平以及高抗CNP滴度是与二尖瓣环钙化独立相关的危险因素。
研究结果表明，CNP可能在MAC的发病机制中起重要作用。
