Unit of Cardiovascular Medicine, Department of Clinical Physiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Unit of Clinical Medicine, Occupational and Environmental Medicine Center, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Sci Rep. 2020 Dec 7;10(1):21390. doi: 10.1038/s41598-020-78286-2.
Vulnerability to stress-induced inflammation has been linked to a dysfunctional hypothalamus-pituitary-adrenal (HPA) axis. In the present study, patients with known or suspected coronary artery disease (CAD) were assessed with respect to inflammatory and HPA axis response to acute physical exercise. An exercise stress test was combined with SPECT myocardial perfusion imaging. Plasma and saliva samples were collected before and 30 min after exercise. Interleukin (IL)-6 and adrenocorticotropic hormone (ACTH) were measured in plasma, while cortisol was measured in both plasma and saliva. In total, 124 patients were included of whom 29% had a prior history of CAD and/or a myocardial perfusion deficit. The levels of exercise intensity and duration were comparable in CAD and non-CAD patients. However, in CAD patients, IL-6 increased after exercise (p = 0.019) while no differences were seen in HPA axis variables. Conversely, patients without CAD exhibited increased levels of ACTH (p = 0.003) and cortisol (p = 0.004 in plasma, p = 0.006 in saliva), but no change in IL-6. We conclude that the IL-6 response to acute physical exercise is exaggerated in CAD patients and may be out of balance due to HPA axis hypoactivity. It remains to be further investigated whether this imbalance is a potential diagnostic and therapeutic target in CAD.
压力引起的炎症易感性与下丘脑-垂体-肾上腺 (HPA) 轴功能障碍有关。在本研究中，评估了已知或疑似冠心病 (CAD) 的患者对急性体力活动的炎症和 HPA 轴反应。将运动应激测试与 SPECT 心肌灌注成像相结合。在运动前和运动后 30 分钟采集血浆和唾液样本。在血浆中测量白细胞介素 (IL)-6 和促肾上腺皮质激素 (ACTH)，在血浆和唾液中测量皮质醇。共纳入 124 例患者，其中 29%有 CAD 病史和/或心肌灌注不足。CAD 和非 CAD 患者的运动强度和持续时间相当。然而，在 CAD 患者中，IL-6 在运动后增加（p=0.019），而 HPA 轴变量无差异。相反，无 CAD 的患者 ACTH（p=0.003）和皮质醇（血浆中 p=0.004，唾液中 p=0.006）水平升高，但 IL-6 无变化。我们得出结论，急性体力活动引起的 IL-6 反应在 CAD 患者中被夸大，可能由于 HPA 轴活性降低而失去平衡。尚需进一步研究这种失衡是否是 CAD 的潜在诊断和治疗靶点。
