Popova Velichka, Geneva-Popova Mariela, Kraev Krasimir, Batalov Anastas
Department of Rheumatology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria.
Rheumatol Int. 2022 Sep;42(9):1589-1596. doi: 10.1007/s00296-022-05113-4. Epub 2022 May 26.
The role of inflammatory cytokines is well researched in acute coronary syndrome (ACS) and rheumatoid arthritis (RA), but not in the presence of both conditions. This study aimed to compare TNF-α expression, serum TNF-α, IL-6, and hs-CRP in ACS patients with RA (n = 46) with ACS patients without RA (n = 49) and healthy controls (n = 50). TNF-α expression was assessed from coronary artery samples, taken during coronary artery bypass surgery. Serum levels TNF-α, IL-6, and hs-CRP were measured 24 and 48 h after cardiac surgery. Stronger TNF-α expression was observed in the ACS patients with RA versus the ACS patients without RA, p = 0.001. Serum TNF-α, IL-6, and hs-CRP at the 24th h were significantly elevated in both patient groups and distinguished them from the healthy controls with accuracy ranging from 80 to 99%. At the 48th h, serum TNF-α and IL-6 in the ACS group without RA decreased to those of the healthy controls but remained high in the group with RA. ACS cases with RA could be correctly identified from the levels of IL-6 (AUC = 0.885, 95% CI 0.791 to 0.938) and TNF-α (AUC = 0.852, 95%CI 0.720 to 0.922). Our results suggest that the presence of RA in ACS cases is likely to provoke stronger TNF-α expression on atherosclerotic plaques, aggravate the pro-inflammatory response, and sustain it even after the cardiac stress is lowered. In ACS cases with RA, long-term monitoring and control of TNF-α and IL-6 levels can be a useful preventive strategy.
炎症细胞因子在急性冠状动脉综合征（ACS）和类风湿关节炎（RA）中的作用已得到充分研究，但在两种疾病并存的情况下尚未得到研究。本研究旨在比较合并RA的ACS患者（n = 46）、不合并RA的ACS患者（n = 49）和健康对照者（n = 50）的TNF-α表达、血清TNF-α、IL-6和hs-CRP水平。通过在冠状动脉搭桥手术期间采集的冠状动脉样本评估TNF-α表达。在心脏手术后24小时和48小时测量血清TNF-α、IL-6和hs-CRP水平。与不合并RA的ACS患者相比，合并RA的ACS患者中观察到更强的TNF-α表达，p = 0.001。两组患者术后24小时的血清TNF-α、IL-6和hs-CRP均显著升高，与健康对照者区分开来，准确率在80%至99%之间。术后48小时，不合并RA的ACS组血清TNF-α和IL-6降至健康对照者水平，但合并RA的组仍保持较高水平。合并RA的ACS病例可根据IL-6（AUC = 0.885，95%CI 0.791至0.938）和TNF-α（AUC = 0.852，95%CI 0.720至0.922）水平正确识别。我们的结果表明，ACS病例中RA的存在可能会引发动脉粥样硬化斑块上更强的TNF-α表达，加重促炎反应，即使在心脏应激降低后仍会持续。在合并RA的ACS病例中，长期监测和控制TNF-α和IL-6水平可能是一种有用的预防策略。
