Department of Cardiology, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Cardiology, Fortaleza, Brazil.
Department of Cardiology, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Cardiology, Fortaleza, Brazil; Department of Internal Medicine, Western Michigan University, Internal Medicine, Kalamazoo, MI, USA.
Rev Port Cardiol (Engl Ed). 2020 Nov;39(11):667-672. doi: 10.1016/j.repc.2020.05.010. Epub 2020 Oct 24.
Biomarkers have a variety of clinical applications in multiple stages of diagnosis and therapy. Troponin T and brain natriuretic peptide are the best-known in the cardiovascular field, but experimental studies have identified new biomarkers with potential clinical value. In this article, novel biomarkers of kidney injury are investigated in the context of their relationship with atherosclerotic coronary disease. This review was carried out through a search in the PubMed database using as keywords each biomarker to be studied with the descriptor (DECS/MeSH) "Myocardial Infarction", and the keywords "coronary" and "cardiovascular", using the Boolean operator "AND". After the selection, 24 articles published between 2003 and 2017 were identified for the review. Eight biomarkers were investigated: neutrophil gelatinase-associated lipocalin (NGAL), fibroblast growth factor 23 (FGF23), tissue inhibitor of metalloproteinase-2 (TIMP-2), syndecan-1, interleukin-6 (IL-6), galectin-3, and the vascular cell adhesion molecules ICAM-1 and VCAM-1. Most identified articles were experimental studies, studies on human subjects having few participants. There are several promising biomarkers in the setting of coronary disease. The main evidence available in the literature suggests that elevated NGAL levels are associated with better prognosis after cardiac arrest and with comorbid kidney injury; elevated FGF23 is associated with coronary artery disease severity; TIMP-2 protects against coronary artery disease; increased expression of syndecan-1 is observed in myocardial infarction (MI) and protects against an exacerbated inflammatory response; IL-6 is associated with atherosclerotic disease and major cardiovascular outcomes; galectin-3 correlates with adverse clinical events post-MI; and elevated ICAM-1/VCAM-1 levels are associated with risk of coronary disease. Further studies are required to better investigate the role of each of these biomarkers in both stable coronary disease and acute coronary syndrome.
生物标志物在诊断和治疗的多个阶段具有多种临床应用。肌钙蛋白 T 和脑利钠肽是心血管领域最著名的标志物，但实验研究已经确定了具有潜在临床价值的新标志物。在本文中，研究了与动脉粥样硬化性冠心病相关的新型肾脏损伤生物标志物。通过在 PubMed 数据库中使用每个待研究的生物标志物作为关键字，并使用描述符（DECS/MeSH）“心肌梗死”和关键字“冠状动脉”和“心血管”进行搜索，使用布尔运算符“AND”。选择后，确定了 2003 年至 2017 年之间发表的 24 篇文章进行综述。研究了 8 种生物标志物：中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、成纤维细胞生长因子 23（FGF23）、基质金属蛋白酶组织抑制剂 2（TIMP-2）、连接蛋白 1、白细胞介素 6（IL-6）、半乳糖凝集素 3，以及血管细胞黏附分子 ICAM-1 和 VCAM-1。大多数已确定的文章都是实验研究，研究对象是人类，参与者较少。在冠心病患者中，有几种很有前途的生物标志物。现有文献中的主要证据表明，心脏骤停后升高的 NGAL 水平与预后较好相关，与合并的肾脏损伤相关；升高的 FGF23 与冠状动脉疾病严重程度相关；TIMP-2 可预防冠状动脉疾病；在心肌梗死（MI）中观察到连接蛋白 1 的表达增加，可防止炎症反应加重；IL-6 与动脉粥样硬化疾病和主要心血管结局相关；半乳糖凝集素 3 与 MI 后不良临床事件相关；升高的 ICAM-1/VCAM-1 水平与冠状动脉疾病风险相关。需要进一步研究以更好地研究这些生物标志物中的每一种在稳定型冠状动脉疾病和急性冠状动脉综合征中的作用。
