Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
Centre of Oncology, Maria Sklodowska-Curie Memorial Institute Cracow Branch, Cracow, Poland.
Clin Rheumatol. 2019 Feb;38(2):417-424. doi: 10.1007/s10067-018-4253-5. Epub 2018 Aug 21.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of vasculitis associated with asthma and eosinophilia. Endothelial dysfunction has been well documented in other types of vasculitis but not in EGPA. Thirty patients (10 men and 20 women) diagnosed with EGPA and remaining in a remission, and 58 controls (24 men and 34 women) matched for age, sex, and body mass index, were enrolled in the study. We assessed each participants for typical risk factors of cardiovascular diseases and measured serum levels of vascular cell adhesion molecule-1 (VCAM-1), interleukin 6 (IL-6), and thrombomodulin. We also measured flow-mediated dilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the common carotid artery using ultrasonography. Patients with EGPA had 20% higher serum level of VCAM-1 (p < 0.001) and 41.9% of thrombomodulin (p < 0.001). They also had 38.8% lower relative increase of FMD (FMD%) (p < 0.001), indicating endothelial dysfunction. These differences remained significant also after adjustment for potential confounders. Laboratory and ultrasonographic parameters of endothelial injury were correlated to the markers of inflammation and impaired kidney function. Determinants of lower FMD% in a simple regression model were pack-years of smoking (β = - 0.3 [95% confidence interval (CI) - 0.5 to - 0.1]), serum level of IL-6 (β = - 0.36 [95% CI - 0.62 to - 0.1]), and thrombomodulin (β = - 0.34 [95% CI - 0.6 to - 0.08]). EGPA patients are characterized by inflammatory endothelial injury that is likely related to the pathogenesis of the disease. Proper immunosuppressive treatment is the best method to prevent atherosclerosis and future cardiovascular events, the patients may also benefit from additional preventive interventions.
嗜酸性肉芽肿伴多血管炎（EGPA）是一种与哮喘和嗜酸性粒细胞增多有关的罕见血管炎。内皮功能障碍在其他类型的血管炎中已有充分的记录，但在 EGPA 中则没有。本研究纳入了 30 名（10 名男性和 20 名女性）处于缓解期的 EGPA 患者和 58 名（24 名男性和 34 名女性）年龄、性别和体重指数相匹配的对照者。我们评估了每位参与者的心血管疾病典型危险因素，并测量了血管细胞黏附分子-1（VCAM-1）、白细胞介素 6（IL-6）和血栓调节蛋白的血清水平。我们还使用超声心动图测量了肱动脉血流介导的扩张（FMD）和颈总动脉内膜中层厚度（IMT）。EGPA 患者的 VCAM-1 血清水平高 20%（p < 0.001），血栓调节蛋白高 41.9%（p < 0.001）。FMD%相对增加低 38.8%（p < 0.001），表明存在内皮功能障碍。这些差异在调整潜在混杂因素后仍然显著。内皮损伤的实验室和超声参数与炎症标志物和肾功能受损相关。在简单回归模型中，FMD%降低的决定因素是吸烟包年数（β = -0.3 [95%置信区间（CI）-0.5 至-0.1]）、IL-6 血清水平（β = -0.36 [95% CI -0.62 至-0.1]）和血栓调节蛋白（β = -0.34 [95% CI -0.6 至-0.08]）。EGPA 患者的特点是炎症性内皮损伤，这可能与疾病的发病机制有关。适当的免疫抑制治疗是预防动脉粥样硬化和未来心血管事件的最佳方法，患者可能还受益于额外的预防干预措施。
