变应性炎症与急性心肌梗死后的冠状动脉不稳定及更差的临床结局相关。
Allergic Inflammation Is Associated With Coronary Instability and a Worse Clinical Outcome After Acute Myocardial Infarction.
作者信息
Niccoli Giampaolo, Calvieri Camilla, Flego Davide, Scalone Giancarla, Imaeva Asya, Sabato Vito, Schiavino Domenico, Liuzzo Giovanna, Crea Filippo
机构信息
From the Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (G.N., G.S., G.L., F.C.); Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy (C.C.); Institute of Allergology, Catholic University of the Sacred Heart, Rome, Italy (D.F., D.S.); Department of Epidemiology of Chronic Non-Communicable Diseases, Federal State Institution National Research Center for Preventive Medicine, Moscow, Russia (A.I.); and Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Belgium (V.S.).
出版信息
Circ Cardiovasc Interv. 2015 Aug;8(8):e002554. doi: 10.1161/CIRCINTERVENTIONS.115.002554.
BACKGROUND
The role of allergic inflammation in acute coronary syndromes (ACS) has not been clearly defined to date. Aim of this study was to assess eosinophil and basophil activation in ACS and the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.
METHODS AND RESULTS
In a cross-sectional study, we prospectively enrolled 51 patients undergoing percutaneous coronary intervention (60.8% patients with ACS and 39.2% with stable angina). Flow cytometry analysis assessed CD66b, CD69, and CD203c median fluorescence intensity expression. In a follow-up study, 181 patients presenting with ST-segment-elevation myocardial infarction, undergoing primary percutaneous coronary intervention, were prospectively enrolled with a follow-up of 24 months. Eosinophil activation (CD66b) was similar in patients with ACS and stable angina (6.61 [4.91-7.72] versus 6.62 [5.27-8.73], P=0.63), whereas eosinophil degranulation (CD69) and basophil activation (CD203c) were higher in ACS patients compared with stable angina patients (1.38 [1.16-1.52] versus 1.17 [1-1.31], P=0.01); 0.97 [0.89-1.11] versus 0.92 [0.87-0.95], P=0.03, respectively). Eosinophil cationic protein serum levels were significantly higher in ST-segment-elevation myocardial infarction patients with major adverse cardiac events as compared with those without (21.1 [10.37-25.65] versus 7.83 [3.37-12.8] μg/L, P=0.01) and in patients with thrombus score >3 compared with those with thrombus score ≤3 (15.0 [9.8-24.7] versus 5.2 [3.5-22.9] μg/L, P=0.006). Eosinophil cationic protein serum levels predicted major adverse cardiac events during follow-up (odds ratio =1.041, 95% confidence interval 1.012-1.071, P=0.005). C-reactive protein serum levels showed a borderline statistical significance (odds ratio =0.904, 95% confidence interval 0.806-1.014, P=0.085).
CONCLUSIONS
These findings are the first demonstration of in vivo eosinophil degranulation and basophil activation during ACS and of the prognostic role of eosinophil cationic protein in ST-segment-elevation myocardial infarction.
背景
迄今为止，过敏炎症在急性冠状动脉综合征（ACS）中的作用尚未明确界定。本研究的目的是评估ACS中嗜酸性粒细胞和嗜碱性粒细胞的活化情况，以及嗜酸性粒细胞阳离子蛋白在ST段抬高型心肌梗死中的预后作用。
方法与结果
在一项横断面研究中，我们前瞻性纳入了51例行经皮冠状动脉介入治疗的患者（60.8%为ACS患者，39.2%为稳定型心绞痛患者）。流式细胞术分析评估了CD66b、CD69和CD203c的中位荧光强度表达。在一项随访研究中，前瞻性纳入了181例表现为ST段抬高型心肌梗死并接受直接经皮冠状动脉介入治疗的患者，随访24个月。ACS患者和稳定型心绞痛患者的嗜酸性粒细胞活化（CD66b）相似（6.61[4.91 - 7.72]对6.62[5.27 - 8.73]，P = 0.63），而与稳定型心绞痛患者相比，ACS患者的嗜酸性粒细胞脱颗粒（CD69）和嗜碱性粒细胞活化（CD203c）更高（1.38[1.16 - 1.52]对1.17[1 - 1.31]，P = 0.01）；分别为0.97[0.89 - 1.11]对0.92[0.87 - 0.95]，P = 0.03）。与无主要不良心脏事件的ST段抬高型心肌梗死患者相比，发生主要不良心脏事件的患者血清嗜酸性粒细胞阳离子蛋白水平显著更高（21.1[10.37 - 25.65]对7.83[3.37 - 12.8]μg/L，P = 0.01），血栓评分>3的患者与血栓评分≤3的患者相比也是如此（15.0[9.8 - 24.7]对5.2[3.5 - 22.9]μg/L，P = 0.006）。血清嗜酸性粒细胞阳离子蛋白水平可预测随访期间的主要不良心脏事件（比值比 = 1.041，95%置信区间1.012 - 1.071，P = 0.005）。血清C反应蛋白水平显示出临界统计学意义（比值比 = 0.904，95%置信区间0.806 - 1.014，P = 0.085）。
结论
这些发现首次证明了ACS期间体内嗜酸性粒细胞脱颗粒和嗜碱性粒细胞活化，以及嗜酸性粒细胞阳离子蛋白在ST段抬高型心肌梗死中的预后作用。
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