Overmars L Malin, Mekke Joost M, van Solinge Wouter W, De Jager Saskia C A, Hulsbergen-Veelken Cornelia A R, Hoefer Imo E, de Kleijn Dominique P V, de Borst Gert J, van der Laan Sander W, Haitjema Saskia
Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Atheroscler Plus. 2023 Jun 1;52:32-40. doi: 10.1016/j.athplu.2023.05.003. eCollection 2023 Jun.
Patients who underwent carotid endarterectomy (CEA) still have a residual risk of 13% of developing a major adverse cardiovascular event (MACE) within 3 years. Inflammatory processes leading up to MACE are not fully understood. Therefore, we examined blood cell characteristics (BCCs), possibly reflecting inflammatory processes, in relation to MACE to identify BCCs that may contribute to an increased risk.
We analyzed 75 pretreatment BCCs from the Sapphire analyzer, and clinical data from the Athero-Express biobank in relation to MACE after CEA using Random Survival Forests, and a Generalized Additive Survival Model. To understand biological mechanisms, we related the identified variables to intraplaque hemorrhage (IPH).
Of 783 patients, 97 (12%) developed MACE within 3 years after CEA. Red blood cell distribution width (RDW) (HR 1.23 [1.02, 1.68], p = 0.022), CV of lymphocyte size (LACV) (HR 0.78 [0.63, 0.99], p = 0.043), neutrophil complexity of the intracellular structure (NIMN) (HR 0.80 [0.64, 0.98], p = 0.033), mean neutrophil size (NAMN) (HR 0.67 [0.55, 0.83], p < 0.001), mean corpuscular volume (MCV) (HR 1.35 [1.09, 1.66], p = 0.005), eGFR (HR 0.65 [0.52, 0.80], p < 0.001); and HDL-cholesterol (HR 0.62 [0.45, 0.85], p = 0.003) were related to MACE. NAMN was related to IPH (OR 0.83 [0.71-0.98], p = 0.02).
This is the first study to present a higher RDW and MCV and lower LACV, NIMN and NAMN as biomarkers reflecting inflammatory processes that may contribute to an increased risk of MACE after CEA.
接受颈动脉内膜切除术（CEA）的患者在3年内仍有13%发生主要不良心血管事件（MACE）的残余风险。导致MACE的炎症过程尚未完全了解。因此，我们研究了可能反映炎症过程的血细胞特征（BCCs）与MACE的关系，以确定可能导致风险增加的BCCs。
我们使用随机生存森林和广义相加生存模型分析了来自蓝宝石分析仪的75个术前BCCs，以及来自Athero-Express生物样本库的与CEA术后MACE相关的临床数据。为了了解生物学机制，我们将识别出的变量与斑块内出血（IPH）相关联。
在783例患者中，97例（12%）在CEA术后3年内发生了MACE。红细胞分布宽度（RDW）（风险比[HR]1.23[1.02,1.68]，p = 0.022）、淋巴细胞大小的变异系数（LACV）（HR 0.78[0.63,0.99]，p = 0.043）、中性粒细胞细胞内结构的复杂性（NIMN）（HR 0.80[0.64,0.98]，p = 0.033）、平均中性粒细胞大小（NAMN）（HR 0.67[0.55,0.83]，p < 0.001）、平均红细胞体积（MCV）（HR 1.35[1.09,1.66]，p = 0.005）、估算肾小球滤过率（eGFR）（HR 0.65[0.52,0.80]，p < 0.001）；以及高密度脂蛋白胆固醇（HDL-胆固醇）（HR 0.62[0.45,0.85]，p = 0.003）与MACE相关。NAMN与IPH相关（比值比[OR]0.83[0.71 - 0.98]，p = 0.02）。
这是第一项提出较高的RDW和MCV以及较低的LACV、NIMN和NAMN作为反映炎症过程的生物标志物的研究，这些炎症过程可能导致CEA术后MACE风险增加。
