Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-024 Lisbon, Portugal.
NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal.
Medicina (Kaunas). 2021 Jan 4;57(1):39. doi: 10.3390/medicina57010039.
: Polyvascular atherosclerosis is frequent and associated with a high cardiovascular risk, although the mechanisms regulating the atherosclerosis extent to single or multiple arterial territories are still poorly understood. Inflammation regulates atherogenesis and soluble CD40 ligand (sCD40L) is an inflammatory mediator associated with the presence of single-territorial atherosclerosis. We assessed whether the sCD40L expression is associated with the atherosclerosis extent to single or multiple arterial territories and with the atherosclerosis severity in different territories. : We prospectively enrolled 94 participants with no atherosclerosis (controls, = 26); isolated coronary atherosclerosis (group 1, = 20); coronary and lower extremity (LE) atherosclerosis (group 2, = 18); coronary and carotid atherosclerosis (group 3, = 12); and coronary, LE, and carotid atherosclerosis (group 4, = 18). Serum sCD40L levels were quantified. The sCD40L levels (ng/mL, mean (standard deviation)) were 4.0 (1.5), 5.6 (2.6), 7.2 (4.2), 5.9 (3.7), and 5.1 (2.4) in controls and groups 1 to 4, respectively (ANOVA = 0.012). In nonrevascularized patients, the sCD40L levels were significantly higher in group 2 than in group 1 and were correlated with the number of LE diseased segments. Prior LE bypass surgery was associated with lower sCD40L levels. Coexistence of coronary and LE atherosclerosis was independently associated with the sCD40L levels. : The sCD40L levels were increased in stable atherosclerosis, particularly in polyvascular coronary and LE atherosclerosis. The number of LE diseased segments and prior LE revascularization were associated with sCD40L expression. To our knowledge, these are novel data, which provide insights into the mechanisms underlying multi-territorial atherosclerosis expression. sCD40L may be a promising noninvasive tool for refining the stratification of the systemic atherosclerotic burden.
多血管粥样硬化很常见，与心血管风险高相关，尽管调节单一或多个动脉区域粥样硬化程度的机制仍知之甚少。炎症调节动脉粥样硬化的发生，可溶性 CD40 配体（sCD40L）是一种与单一区域动脉粥样硬化存在相关的炎症介质。我们评估了 sCD40L 的表达是否与单一或多个动脉区域的动脉粥样硬化程度以及不同区域的动脉粥样硬化严重程度相关。
我们前瞻性纳入了 94 名无动脉粥样硬化（对照组，n = 26）、孤立性冠状动脉粥样硬化（第 1 组，n = 20）、冠状动脉和下肢（LE）动脉粥样硬化（第 2 组，n = 18）、冠状动脉和颈动脉粥样硬化（第 3 组，n = 12）以及冠状动脉、LE 和颈动脉粥样硬化（第 4 组，n = 18）的患者。定量检测血清 sCD40L 水平。sCD40L 水平（ng/mL，平均值 ± 标准差）分别为对照组为 4.0 ± 1.5，第 1 组为 5.6 ± 2.6，第 2 组为 7.2 ± 4.2，第 3 组为 5.9 ± 3.7，第 4 组为 5.1 ± 2.4（方差分析，F = 0.012）。在未经血运重建的患者中，第 2 组的 sCD40L 水平显著高于第 1 组，且与 LE 病变节段数相关。LE 旁路手术史与 sCD40L 水平降低相关。冠状动脉和 LE 动脉粥样硬化共存与 sCD40L 水平独立相关。
在稳定的动脉粥样硬化中，sCD40L 水平升高，尤其是多血管冠状动脉和 LE 动脉粥样硬化。LE 病变节段数和 LE 血运重建与 sCD40L 表达相关。据我们所知，这些是新的数据，为多区域动脉粥样硬化表达的潜在机制提供了新的见解。sCD40L 可能是一种有前途的非侵入性工具，可用于细化全身性动脉粥样硬化负担的分层。
