Vita J A, Keaney J F, Raby K E, Morrow J D, Freedman J E, Lynch S, Koulouris S N, Hankin B R, Frei B
Evans Memorial Department of Medicine and Whitaker Cardiovascular Institute, Boston University Medical Center, Massachusetts 02118, USA.
J Am Coll Cardiol. 1998 Apr;31(5):980-6. doi: 10.1016/s0735-1097(98)00059-x.
This study sought to investigate the relations between plasma antioxidant status, extent of atherosclerosis and activity of coronary artery disease.
Previous studies indicate that increased antioxidant intake is associated with decreased coronary disease risk, but the underlying mechanisms remain controversial.
Plasma samples were obtained from 149 patients undergoing cardiac catheterization (65 with stable angina, 84 with unstable angina or a myocardial infarction within 2 weeks). Twelve plasma antioxidant/oxidant markers were measured and correlated with the extent of atherosclerosis and the presence of an unstable coronary syndrome.
By multiple linear regression analysis, age (p < 0.001), diabetes mellitus (p < 0.001), male gender (p < 0.001) and hypercholesterolemia (p = 0.02) were independent predictors of the extent of atherosclerosis. No antioxidant/oxidant marker correlated with the extent of atherosclerosis. However, lower plasma ascorbic acid concentration predicted the presence of an unstable coronary syndrome by multiple logistic regression (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.40 to 0.89, p = 0.01). The severity of atherosclerosis also predicted the presence of an unstable coronary syndrome (OR 1.7, 95% CI 1.14 to 2.47, p = 0.008) when all patients were considered. When only patients with significant coronary disease were considered (at least one stenosis >50%), ascorbic acid concentration (OR 0.56, 95% CI 0.37 to 0.85, p = 0.008) and total plasma thiols (OR 0.52, 95% CI 0.34 to 0.80, p = 0.004) predicted the presence of an unstable coronary syndrome, whereas the extent of atherosclerosis did not.
These data are consistent with the hypothesis that the beneficial effects of antioxidants in coronary artery disease may result, in part, by an influence on lesion activity rather than a reduction in the overall extent of fixed disease.
本研究旨在探讨血浆抗氧化状态、动脉粥样硬化程度与冠状动脉疾病活动之间的关系。
先前的研究表明，增加抗氧化剂摄入量与降低冠心病风险相关，但潜在机制仍存在争议。
从149例接受心导管检查的患者中获取血浆样本（65例稳定型心绞痛患者，84例不稳定型心绞痛患者或2周内发生心肌梗死的患者）。检测了12种血浆抗氧化/氧化标记物，并将其与动脉粥样硬化程度和不稳定型冠状动脉综合征的存在情况进行关联分析。
通过多元线性回归分析，年龄（p < 0.001）、糖尿病（p < 0.001）、男性（p < 0.001）和高胆固醇血症（p = 0.02）是动脉粥样硬化程度的独立预测因素。没有抗氧化/氧化标记物与动脉粥样硬化程度相关。然而，通过多元逻辑回归分析，较低的血浆抗坏血酸浓度可预测不稳定型冠状动脉综合征的存在（比值比[OR] 0.59，95%置信区间[CI] 0.40至0.89，p = 0.01）。当考虑所有患者时，动脉粥样硬化的严重程度也可预测不稳定型冠状动脉综合征的存在（OR 1.7，95% CI 1.14至2.47，p = 0.008）。当仅考虑患有严重冠状动脉疾病的患者（至少一处狭窄>50%）时，抗坏血酸浓度（OR 0.56，95% CI 0.37至0.85，p = 0.008）和总血浆硫醇（OR 0.52，95% CI 0.34至0.80，p = 0.004）可预测不稳定型冠状动脉综合征的存在，而动脉粥样硬化程度则不能。
这些数据与以下假设一致，即抗氧化剂在冠状动脉疾病中的有益作用可能部分是通过对病变活动的影响，而非减少固定疾病的总体程度。
