Lippi Giuseppe, Cervellin Gianfranco, Sanchis-Gomar Fabian
Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma , Parma , Italy.
Ann Med. 2014 Nov;46(7):456-63. doi: 10.3109/07853890.2014.927714. Epub 2014 Jul 1.
Several lines of evidence demonstrate that the immune system plays a pivotal role in development and progression of ischemic heart disease (IHD). More recently, a series of biological and clinical investigations has generated new interest about the existence of a relationship between a specific class of immunoglobulin, that is immunoglobulin E (IgE), and IHD. Data obtained in several epidemiological studies have convincingly demonstrated that the concentration of total serum IgEs is significantly increased in patients with IHD and often correlates with the prognosis. The putative mechanisms are essentially mediated by a physiological interaction between IgEs and mast cells, which triggers the direct or indirect release of a variety of substances that are actively involved in the pathogenesis of myocardial ischemia and thrombosis. Regardless of these important evidences, a causality dilemma remains, since it is still unclear whether increased IgE levels are a consequence of IHD or, rather, IHD is an underlying cause of increased IgE levels. The answer would allow us to recognize whether total IgEs may be considered simple biomarkers or risk factors of IHD, thus paving the way to investigations focused on immunotherapy or avoidance of allergenic foods for reducing serum IgEs in patients at risk of IHD.
多项证据表明，免疫系统在缺血性心脏病（IHD）的发生和发展中起着关键作用。最近，一系列生物学和临床研究引发了人们对一类特定免疫球蛋白即免疫球蛋白E（IgE）与IHD之间关系的新兴趣。多项流行病学研究获得的数据令人信服地表明，IHD患者血清总IgE浓度显著升高，且常与预后相关。推测的机制主要由IgE与肥大细胞之间的生理相互作用介导，这会触发多种物质的直接或间接释放，这些物质积极参与心肌缺血和血栓形成的发病机制。尽管有这些重要证据，但因果关系仍存在困境，因为目前尚不清楚IgE水平升高是IHD的结果，还是相反，IHD是IgE水平升高的潜在原因。这个答案将使我们能够确定总IgE是否可被视为IHD的简单生物标志物或危险因素，从而为专注于免疫治疗或避免食用致敏食物以降低IHD风险患者血清IgE水平的研究铺平道路。
