Cuculo A, Summaria F, Schiavino D, Liuzzo G, Meo A, Patriarca G, Maseri A, Biasucci L M
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma.
Cardiologia. 1998 Feb;43(2):189-93.
Activated mast cells are present in human coronary atheromas, as well as in the adventitia of patients with variant angina, and may play an important role in plaque rupture and coronary vasomotion. To assess whether or not activation of mast cells is a primary event, we measured serum levels of tryptase, a specific marker of mast cell activation, in 8 patients with unstable angina during a spontaneous ischemic episode (Group 1) and in 5 patients with variant angina (Group 2) during ergonovine-induced coronary spasm. Blood samples were collected as soon as possible after the onset of pain and ECG changes (0 min), and after 5, 15 and 60 min. Tryptase levels in Group 1 were 0.13 U/l (range 0.017-0.44) at the onset of pain and significantly raised to 0.75 U/l (range 0.05-2.49) at 5 min, decreasing to 0.076 U/l (range 0.018-0.16) at 15 min and to 0.085 U/l (range 0.01-0.25) at 60 min (p = 0.035). Conversely, tryptase levels in Group 2 were 0.09 U/l (range 0.07-0.13) at 0 min, 0.11 U/l (range 0.07-0.22) at 5 min, 0.10 U/l (range 0.07-0.18) at 15 min, 0.11 U/l (range 0.07-0.17) at 60 min (NS). In conclusion, tryptase levels raise during spontaneous ischemic episodes in unstable angina, but not after ergonovine-provoked ischemia in variant angina, suggesting that a primary, yet unknown stimulus, may activate mast cells during some ischemic episodes in unstable angina.
活化的肥大细胞存在于人类冠状动脉粥样硬化斑块中，也存在于变异型心绞痛患者的血管外膜中，可能在斑块破裂和冠状动脉血管运动中起重要作用。为了评估肥大细胞的激活是否为原发性事件，我们测量了8例不稳定型心绞痛患者在自发性缺血发作期间（第1组）以及5例变异型心绞痛患者在麦角新碱诱发的冠状动脉痉挛期间（第2组）血清类胰蛋白酶水平，类胰蛋白酶是肥大细胞激活的特异性标志物。在疼痛和心电图改变发作后尽快（0分钟）以及5、15和60分钟后采集血样。第1组类胰蛋白酶水平在疼痛发作时为0.13 U/l（范围0.017 - 0.44），5分钟时显著升高至0.75 U/l（范围0.05 - 2.49），15分钟时降至0.076 U/l（范围0.018 - 0.16），60分钟时降至0.085 U/l（范围0.01 - 0.25）（p = 0.035）。相反，第2组类胰蛋白酶水平在0分钟时为0.09 U/l（范围0.07 - 0.13），5分钟时为0.11 U/l（范围0.07 - 0.22），15分钟时为0.10 U/l（范围0.07 - 0.18），60分钟时为0.11 U/l（范围0.07 - 0.17）（无显著性差异）。总之，不稳定型心绞痛患者在自发性缺血发作期间类胰蛋白酶水平升高，但变异型心绞痛患者在麦角新碱诱发的缺血后未升高，这表明在不稳定型心绞痛的某些缺血发作期间，一种原发性但未知的刺激可能激活肥大细胞。
