Koganti Sudheer, Eleftheriou Despina, Brogan Paul A, Kotecha Tushar, Hong Ying, Rakhit Roby D
Department of Cardiology Royal Free Hospital Pond Street, London, Uk NW3 2QG; UCL Institute of Cardiovascular Science Gower Street London WC1E 6BT.
UCL Great Ormond Street Institute of Child Health 30 Guilford Street London WC1N 1EH.
Int J Cardiol. 2017 Mar 1;230:339-345. doi: 10.1016/j.ijcard.2016.12.108. Epub 2016 Dec 22.
Despite significant advances in prevention, medical and interventional management, coronary artery disease (CAD) remains the leading cause of death worldwide. Although the number of people being diagnosed with CAD has plateaued in the western world, it is projected to increase significantly in the developing world reaching epidemic proportions, particularly in South Asia. To better stratify the risk of developing and suffering a cardiovascular event due to CAD, not only plasma biomarkers relating to disease burden but also disease activity in CAD are needed; this will allow targeting of appropriate management to high-risk patients for acute events. Over the last twenty years, data have emerged showing the role of sub-micron vesicles called microparticles (MPs) in the pathogenesis of formation and evolution of atherosclerotic plaques causing either stable angina (SA) or acute coronary syndromes (ACS). Herein we provide an overview of our current knowledge of MP formation, composition and possible mechanisms through which they could be contributing to CAD. We also reviewed currently available methods and their limitations in quantifying MPs and in determining their functional aspects. Role of various treatments ranging from dietary substitutes to oral medicines and intravenous medications to mechanistic procedures such as hemofiltration are elaborated. Although evidence implicating the role of MPs in CAD are mounting large scale prospective studies are still lacking and are the need of the hour prior to establishing the use of MPs as biomarkers for the early detection of CAD and its progression.
尽管在预防、医学和介入治疗方面取得了重大进展，但冠状动脉疾病（CAD）仍然是全球主要的死亡原因。虽然在西方世界，被诊断出患有CAD的人数已趋于平稳，但预计在发展中世界，这一数字将显著增加，达到流行程度，尤其是在南亚。为了更好地分层因CAD发生心血管事件和患病的风险，不仅需要与疾病负担相关的血浆生物标志物，还需要CAD中的疾病活动指标；这将有助于针对急性事件的高危患者进行适当的治疗。在过去的二十年中，有数据表明称为微粒（MPs）的亚微米囊泡在导致稳定型心绞痛（SA）或急性冠状动脉综合征（ACS）的动脉粥样硬化斑块形成和演变的发病机制中发挥作用。在此，我们概述了我们目前对MP形成、组成以及它们可能导致CAD的机制的认识。我们还回顾了目前可用的方法及其在量化MPs和确定其功能方面的局限性。阐述了从饮食替代物到口服药物、静脉药物以及诸如血液滤过等机械程序等各种治疗方法的作用。尽管暗示MPs在CAD中作用的证据越来越多，但仍缺乏大规模前瞻性研究，在将MPs用作早期检测CAD及其进展的生物标志物之前，这是当务之急。
