Kovanen P T, Mänttäri M, Palosuo T, Manninen V, Aho K
Wihuri Research Institute, Helsinki, Finland.
Arch Intern Med. 1998 Jul 13;158(13):1434-9. doi: 10.1001/archinte.158.13.1434.
Immune mechanisms have been suggested to play an important role in the development of coronary atherosclerosis and its thrombotic complications. We evaluated the predictive value of the levels of various serum immunoglobulin classes in middle-aged men at increased risk of myocardial infarction.
Using nested case-control design and logistic regression analysis, we estimated the association between serum immunoglobulins and the risk of coronary end points (nonfatal or fatal myocardial infarction or sudden cardiac death) in dyslipidemic men (levels of non-high-density lipoprotein cholesterol >5.2 mmol/L [>201 mg/dL]) participating in the Helsinki Heart Study. The cases consisted of 135 subjects in whom a coronary end point occurred during the 5-year observation period of the study, and the controls were 135 subjects who did not suffer coronary end points during this period. Levels of IgA, IgE, IgG, and IgM were determined in serum samples collected at study entry.
Levels of IgA, IgE, and IgG, but not IgM, were significantly higher in cases than in controls. After adjustment for other risk factors, such as age, smoking, and blood pressure, the risk of coronary disease showed a significant relation to the levels of IgA, IgE, and IgG. The risk in the highest quartile of each distribution as compared with the lowest quartile was 2.2-fold for IgA (95% confidence interval, 1.0-4.5), 2.8-fold for IgE (1.3-5.9), and 2.8-fold for IgG (1.3-5.9). Hypertriglyceridemia and a low level of high-density lipoprotein cholesterol were associated with increased risk of a coronary end point only if the levels of IgA, IgE, or IgG were also elevated.
Elevated levels of IgA, IgE, and IgG are associated with myocardial infarction and cardiac death in men with dyslipidemia. The present data suggest that, for dyslipidemia to cause coronary atherothrombosis, an immune response reflected by elevated levels of these immunoglobulin classes is an important determinant.
免疫机制被认为在冠状动脉粥样硬化及其血栓形成并发症的发展中起重要作用。我们评估了血清中各种免疫球蛋白水平对有心肌梗死风险增加的中年男性的预测价值。
采用巢式病例对照设计和逻辑回归分析，我们估计了血脂异常男性（非高密度脂蛋白胆固醇水平>5.2 mmol/L[>201 mg/dL]）参与赫尔辛基心脏研究中血清免疫球蛋白与冠状动脉终点事件（非致命或致命性心肌梗死或心源性猝死）风险之间的关联。病例组由135名在研究的5年观察期内发生冠状动脉终点事件的受试者组成，对照组为135名在此期间未发生冠状动脉终点事件的受试者。在研究开始时采集的血清样本中测定IgA、IgE、IgG和IgM的水平。
病例组中IgA、IgE和IgG水平显著高于对照组，而IgM水平无显著差异。在调整了年龄、吸烟和血压等其他危险因素后，冠心病风险与IgA、IgE和IgG水平呈显著相关。与最低四分位数相比，每种分布最高四分位数的风险，IgA为2.2倍（95%置信区间，1.0 - 4.5），IgE为2.8倍（1.3 - 5.9），IgG为2.8倍（1.3 - 5.9）。仅当IgA、IgE或IgG水平也升高时，高甘油三酯血症和低水平高密度脂蛋白胆固醇才与冠状动脉终点事件风险增加相关。
IgA、IgE和IgG水平升高与血脂异常男性的心肌梗死和心源性死亡相关。目前的数据表明，对于血脂异常导致冠状动脉粥样血栓形成，这些免疫球蛋白水平升高所反映的免疫反应是一个重要的决定因素。
