Poredoš Pavel, Ježovnik Mateja Kaja
1 Internal Medicine at Medical Faculty, University Medical Centre Ljubljana, Slovenia.
Vasa. 2015 Jul;44(4):247-56. doi: 10.1024/0301-1526/a000439.
The estimation of risk for atherosclerotic and cardiovascular events based only on the presence of classical risk factors is often insufficient. Therefore, efforts have been made to find markers that indicate the presence of preclinical disease in individual subjects: blood markers of atherosclerosis and preclinical deterioration of the arterial wall. Elevated levels of several inflammatory mediators have been found in subjects with atherosclerosis. Increased basal levels of cytokines, the cell adhesion molecules, selectins and acute-phase reactants such as high sensitive C-reactive protein (hsCRP), fibrinogen, and serum amyloid A are related to an increased risk of cardiovascular events. For clinical purposes, the most promising inflammatory biomarker appears to be hsCRP. In the last decade, markers of plaque stability and unstable coronary artery disease have been sought. Further, markers of endothelial dysfunction, like circulating molecules as well as indicators of functional deterioration of the arterial wall were identified. It was shown that endothelial dysfunction is closely related to different risk factors of atherosclerosis, and to their intensity and duration. Intima-media thickness measurement has emerged as one of the methods of choice for determining the anatomic extent of preclinical atherosclerosis and for assessing cardiovascular risk.Determination of markers of preclinical atherosclerosis improve individual risk determination and could influence the decision of a clinician to intervene with medication and to use more aggressive treatment of risk factors in high risk subjects and in patients with atherosclerotic disease.
仅基于经典危险因素的存在来估计动脉粥样硬化和心血管事件的风险往往是不够的。因此，人们一直在努力寻找能够指示个体受试者临床前疾病存在的标志物：动脉粥样硬化的血液标志物和动脉壁的临床前恶化情况。在患有动脉粥样硬化的受试者中发现了几种炎症介质水平升高。细胞因子、细胞黏附分子、选择素和急性期反应物（如高敏C反应蛋白（hsCRP）、纤维蛋白原和血清淀粉样蛋白A）的基础水平升高与心血管事件风险增加有关。就临床目的而言，最有前景的炎症生物标志物似乎是hsCRP。在过去十年中，人们一直在寻找斑块稳定性和不稳定型冠状动脉疾病的标志物。此外，还确定了内皮功能障碍的标志物，如循环分子以及动脉壁功能恶化的指标。研究表明，内皮功能障碍与动脉粥样硬化的不同危险因素及其强度和持续时间密切相关。内膜中层厚度测量已成为确定临床前动脉粥样硬化的解剖范围和评估心血管风险的首选方法之一。确定临床前动脉粥样硬化的标志物可改善个体风险评估，并可能影响临床医生决定是否进行药物干预以及对高危受试者和动脉粥样硬化疾病患者采取更积极的危险因素治疗措施。
