Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Atherosclerosis. 2020 Jun;302:1-7. doi: 10.1016/j.atherosclerosis.2020.04.014. Epub 2020 Apr 24.
Endothelial glycocalyx covers the endothelium and maintains vascular integrity. However, its association with the severity and vulnerability of coronary artery disease (CAD) remains to be elucidated.
A total of 259 consecutive patients with stable CAD requiring percutaneous coronary intervention (PCI) were prospectively enrolled. Patients were classified into 2 groups according to the median value of serum syndecan-1, which is a core component of the endothelial glycocalyx (lower syndecan-1 group [syndecan-1 <99.0 ng/mL], n = 130; higher syndecan-1 group [syndecan-1 ≥99.0 ng/mL], n = 129). Severity of CAD and focal plaque vulnerability in culprit lesion were evaluated using angiography and optical coherence tomography.
There was no significant difference in clinical characteristics between the lower syndecan-1 group and the higher syndecan-1 group other than the prevalence of family history of CAD (19 vs. 32%, p = 0.022), prior PCI history (45 vs. 60%, p = 0.015) and estimated glomerular filtration rate (57.8 ± 17.2 vs. 50.9 ± 25.6 ml/min/1.73 m, p = 0.011). Although disease severity on angiogram was comparable between the 2 groups, the prevalence of lipid-rich plaque (40 vs. 19%, p = 0.004) and thin-cap fibroatheroma (20 vs. 6%, p = 0.006) was significantly higher in the lower syndecan-1 group than the higher syndecan-1 group. Lower syndecan-1 level was independently associated with higher prevalence of lipid-rich plaque (odds ratio 3.626, 95% confidence interval 1.535-8.566, p = 0.003).
Lower syndecan-1 level was associated with higher prevalence of vulnerable plaque in patients with CAD. This finding suggests the association between impaired endothelial glycocalyx and the development of vulnerable plaque.
内皮糖萼覆盖在内皮细胞表面，维持血管完整性。然而，其与冠状动脉疾病（CAD）严重程度和易损性的关系仍有待阐明。
前瞻性纳入 259 例拟行经皮冠状动脉介入治疗（PCI）的稳定型 CAD 患者。根据血清硫酸乙酰肝素蛋白聚糖-1（核心成分的内皮糖萼）的中位数将患者分为 2 组（硫酸乙酰肝素蛋白聚糖-1 较低组[硫酸乙酰肝素蛋白聚糖-1<99.0ng/ml]，n=130；硫酸乙酰肝素蛋白聚糖-1 较高组[硫酸乙酰肝素蛋白聚糖-1≥99.0ng/ml]，n=129）。采用血管造影和光学相干断层扫描评估 CAD 严重程度和罪犯病变中斑块易损性。
与硫酸乙酰肝素蛋白聚糖-1 较高组相比，硫酸乙酰肝素蛋白聚糖-1 较低组除 CAD 家族史患病率（19%比 32%，p=0.022）、既往 PCI 史（45%比 60%，p=0.015）和估算肾小球滤过率（57.8±17.2ml/min/1.73m2比 50.9±25.6ml/min/1.73m2，p=0.011）外，临床特征无显著差异。虽然 2 组的造影严重程度相当，但硫酸乙酰肝素蛋白聚糖-1 较低组的富含脂质斑块（40%比 19%，p=0.004）和薄帽纤维粥样斑块（20%比 6%，p=0.006）的患病率明显更高。硫酸乙酰肝素蛋白聚糖-1 水平较低与富含脂质斑块的患病率较高独立相关（优势比 3.626，95%置信区间 1.535-8.566，p=0.003）。
硫酸乙酰肝素蛋白聚糖-1 水平较低与 CAD 患者易损斑块的患病率较高相关。这一发现提示内皮糖萼受损与易损斑块的形成之间存在关联。
