Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Atherosclerosis. 2018 Feb;269:245-251. doi: 10.1016/j.atherosclerosis.2018.01.010. Epub 2018 Jan 17.
This study examined the impact of CD14CD16 monocytes on coronary plaque vulnerability, as assessed by optical coherence tomography (OCT), and investigated their association with daily glucose fluctuation. Although increased CD14CD16 monocyte levels have been reported to increase cardiovascular events, their impact on coronary plaque vulnerability in coronary artery disease (CAD) patients with or without diabetes mellitus (DM) remains unclear.
This prospective observational study included 50 consecutive patients with CAD, receiving lipid-lowering therapy and undergoing coronary angiography and OCT. Patients were divided into 3 tertiles according to the CD14CD16 monocyte percentages assessed by flow cytometry. Standard OCT parameters were assessed for 97 angiographically intermediate lesions (diameter stenosis: 30-70%). Daily glucose fluctuation was analyzed by measuring the mean amplitude of glycemic excursion (MAGE).
CD14CD16 monocytes negatively correlated with fibrous cap thickness (r = -0.508, p < 0.01). The presence of thin-cap fibroatheroma (TCFA) was increased stepwise according to the tertile of CD14CD16 monocytes (0 [tertile 1] vs. 5 [tertile 2] vs. 10 [tertile 3], p < 0.01). CD14CD16 monocytes were a significant determinant of TCFA (OR 1.279, p = 0.001). In non-DM patients, a significant relationship was found between CD14CD16 monocytes and MAGE (r = 0.477, p = 0.018).
CD14CD16 monocytes were associated with coronary plaque vulnerability in CAD patients with well-regulated lipid levels both in DM and non-DM patients. Cross-talk between glucose fluctuation and CD14CD16 monocytes may enhance plaque vulnerability, particularly in non-DM patients. CD14CD16 monocytes could be a possible therapeutic target for coronary plaque stabilization.
本研究通过光学相干断层扫描（OCT）评估 CD14CD16 单核细胞对冠状动脉斑块易损性的影响，并探讨其与每日血糖波动的关系。虽然已有研究报道，CD14CD16 单核细胞水平升高与心血管事件增加相关，但它们对伴或不伴糖尿病（DM）的冠心病（CAD）患者冠状动脉斑块易损性的影响尚不清楚。
本前瞻性观察性研究纳入了 50 例连续接受降脂治疗并接受冠状动脉造影和 OCT 的 CAD 患者。患者根据流式细胞术评估的 CD14CD16 单核细胞百分比分为 3 个三分位组。对 97 个血管造影中间病变（直径狭窄 30%-70%）评估标准 OCT 参数。通过测量平均血糖波动幅度（MAGE）分析每日血糖波动。
CD14CD16 单核细胞与纤维帽厚度呈负相关（r=-0.508，p<0.01）。薄帽纤维粥样瘤（TCFA）的存在随着 CD14CD16 单核细胞三分位的增加而呈阶梯式增加（0[三分位 1] vs. 5[三分位 2] vs. 10[三分位 3]，p<0.01）。CD14CD16 单核细胞是 TCFA 的重要决定因素（OR 1.279，p=0.001）。在非 DM 患者中，CD14CD16 单核细胞与 MAGE 之间存在显著相关性（r=0.477，p=0.018）。
在 DM 和非 DM 患者中，脂质水平控制良好的 CAD 患者的 CD14CD16 单核细胞与冠状动脉斑块易损性相关。血糖波动与 CD14CD16 单核细胞之间的相互作用可能会增强斑块易损性，尤其是在非 DM 患者中。CD14CD16 单核细胞可能是稳定冠状动脉斑块的潜在治疗靶点。
