Mazzone Annamaria, Parri Maria Serena, Giannessi Daniela, Ravani Marcello, Vaghetti Marco, Altieri Paola, Casalino Laura, Maltinti Maristella, Balbi Manrico, Barsotti Antonio, Berti Sergio
Department of Cardiology, Heart Hospital, Fondazione Toscana G. Monasterio/CNR, Massa, Italy.
Coron Artery Dis. 2011 May;22(3):179-87. doi: 10.1097/MCA.0b013e3283441d0b.
Growing evidence supports the role played by inflammation in atherosclerosis. Identifying sensitive biomarkers is useful in predicting accelerated atherosclerosis. We investigated prospectively the relationship between plasma levels of inflammatory biomarkers [osteopontin, C-reactive protein (CRP), interleukin-6 (IL-6)] and instent restenosis, and rapid coronary plaque progression in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).
We studied 77 patients with CAD: 45 affected by unstable angina/non-ST elevation myocardial infarction [acute coronary syndrome (ACS)], and 32 by chronic coronary syndrome (CCS). Plasma osteopontin, IL-6, and CRP levels were measured before intervention in all patients; measurements were carried out on the basis of the following time course at 1,15, 30, 90, and 180 days follow-up in a subgroup of 39 consenting patients. Clinical and biohumoral data were correlated with baseline and 6-month PCI follow-up angiography.
Osteopontin, IL-6, and CRP were higher in patients with ACS than in those with CCS (analysis of variance: P<0.001, 0.05, and 0.05, respectively). Baseline osteopontin levels proved to be associated with rapid coronary plaque progression (P=0.005) and instent restenosis (P=0.05). The highest osteopontin levels were found in patients with CAD with both rapid plaque progression and instent restenosis (P=0.003). PCI increased inflammatory markers acutely, and osteopontin remained elevated in patients with ACS. Patients with ACS showed a higher percentage (74%) of rapid plaque progression than those with CCS (26%) (P<0.05).
The study prospectively shows the link between inflammatory status and accelerated atherosclerosis in patients with CAD undergoing PCI. The baseline and persistent rise of osteopontin is an expression of its contribution to the accelerated plaque progression, and therefore osteopontin may be a useful prognostic biomarker.
越来越多的证据支持炎症在动脉粥样硬化中所起的作用。识别敏感的生物标志物有助于预测动脉粥样硬化的加速发展。我们前瞻性地研究了炎症生物标志物[骨桥蛋白、C反应蛋白（CRP）、白细胞介素-6（IL-6）]的血浆水平与接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者支架内再狭窄及冠状动脉斑块快速进展之间的关系。
我们研究了77例CAD患者：45例患有不稳定型心绞痛/非ST段抬高型心肌梗死[急性冠状动脉综合征（ACS）]，32例患有慢性冠状动脉综合征（CCS）。在所有患者干预前测量血浆骨桥蛋白、IL-6和CRP水平；在39例同意参与的患者亚组中，根据以下时间进程在1、15、30、90和180天随访时进行测量。临床和生物体液数据与基线及PCI术后6个月的血管造影结果相关。
ACS患者的骨桥蛋白、IL-6和CRP水平高于CCS患者（方差分析：P分别<0.001、0.05和0.05）。基线骨桥蛋白水平被证明与冠状动脉斑块快速进展（P=0.005）和支架内再狭窄（P=0.05）相关。在CAD患者中，同时出现斑块快速进展和支架内再狭窄的患者骨桥蛋白水平最高（P=0.003）。PCI可使炎症标志物急性升高，且ACS患者的骨桥蛋白水平持续升高。ACS患者斑块快速进展的比例（74%）高于CCS患者（26%）（P<0.05）。
该研究前瞻性地显示了接受PCI的CAD患者炎症状态与动脉粥样硬化加速发展之间的联系。骨桥蛋白的基线水平及持续升高表明其对斑块加速进展有影响，因此骨桥蛋白可能是一种有用的预后生物标志物。
