血液中性粒细胞数量与脂蛋白(a)增高患者弥漫性冠状动脉受累有关

A. Filatova, E. A. Larina, O. Afanasieva, L. Ilina, N. V. Radukhina, M. Afanasieva, E. Klesareva, A. Shiryaev, S. Kurbanov, E. Vlasova, V. Vasiliev, S. Pokrovsky, T. Arefieva
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In peripheral blood samples, the content of the main fractions of lipoproteins, including Lp(a), was determined. Activation of neutrophil granulocytes upon addition of Lp(a) was assessed in whole blood and in primary cell culture.Results. In patients with diffuse coronary stenosis, there was a tendency to higher Lp(a) levels; no changes in other lipid profile parameters were detected. In this group of patients, an increase in the absolute leukocyte count was noted due to neutrophilic granulocytes. An absolute neutrophil count >2,9 million/mL was associated with diffuse disease (AUC, 0,69 (95% confidence interval (CI) 0,600,77), p=0,0002, sensitivity 85%, specificity 42%). In patients with Lp(a) ³30 mg/dL, the diagnostic value of a neutrophil count >2,9 million/mL for diffuse stenosis was higher (AUC, 0,74 (95% CI 0,60-0,86), p= 0,005, sensitivity 90%, specificity 48%). 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引用次数: 0

摘要

目的评估接受冠状动脉搭桥手术(CABG)的局灶性和弥漫性冠状动脉粥样硬化患者的脂蛋白(a)(Lp(a))水平及其他血脂谱参数、血液中白细胞的组成,并研究 Lp(a)对体外白细胞活化的影响。研究对象包括 120 名男性患者(平均年龄为 67±5 岁),他们都是在选择性 CABG 手术后患有多支冠状动脉疾病的。根据冠状动脉受累的类型,患者被分为弥漫性动脉粥样硬化组(77 人)和局灶性动脉粥样硬化组(43 人)。在外周血样本中,测定了脂蛋白主要组分的含量,包括脂蛋白(a)。在全血和原代细胞培养中,评估了加入脂蛋白(a)后中性粒细胞的活化情况。在弥漫性冠状动脉狭窄患者中,脂蛋白(a)水平呈上升趋势;其他血脂谱参数未发现变化。在这组患者中,中性粒细胞导致白细胞绝对计数增加。中性粒细胞绝对计数大于 290 万/毫升与弥漫性疾病有关(AUC,0,69(95% 置信区间(CI)0,600,77),p=0,0002,敏感性 85%,特异性 42%)。在脂蛋白(a)³30 毫克/分升的患者中,中性粒细胞计数大于 290 万/毫升对弥漫性血管狭窄的诊断价值更高(AUC,0,74(95% CI 0,60-0,86),p= 0,005,敏感性 90%,特异性 48%)。逻辑回归分析将中性粒细胞和常规风险因素(年龄、体重指数、高血压和吸烟)引入模型后发现,只有中性粒细胞数量超过阈值仍是弥漫性冠状动脉狭窄的独立因素。脂蛋白(a)可诱导中性粒细胞活化(通过全血中 CD66b 的过度表达以及原代细胞培养中性粒细胞胞外陷阱的形成检测到)。中性粒细胞可参与弥漫性冠状动脉粥样硬化病变的形成。脂蛋白(a)可能是中性粒细胞激活剂之一。血液中的中性粒细胞数量和脂蛋白(a)水平过高会增加弥漫性冠状动脉粥样硬化的风险。
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Number of blood neutrophil granulocytes is associated with diffuse coronary involvement in patients with increased lipoprotein (a)
Aim. To assess the level of lipoprotein (a) (Lp(a)) and other lipid profile parameters, the composition of blood leukocytes in patients with focal and diffuse coronary atherosclerosis who underwent coronary artery bypass surgery (CABG), as well as to study the effect of Lp(a) on the activation of leukocytes in vitro.Material and methods. The study included 120 male patients (mean age, 67±5 years) with multivessel coronary artery disease after elective CABG surgery. According to the type of coronary artery involvement, patients were divided into groups of diffuse (n=77) and focal (n=43) atherosclerosis. In peripheral blood samples, the content of the main fractions of lipoproteins, including Lp(a), was determined. Activation of neutrophil granulocytes upon addition of Lp(a) was assessed in whole blood and in primary cell culture.Results. In patients with diffuse coronary stenosis, there was a tendency to higher Lp(a) levels; no changes in other lipid profile parameters were detected. In this group of patients, an increase in the absolute leukocyte count was noted due to neutrophilic granulocytes. An absolute neutrophil count >2,9 million/mL was associated with diffuse disease (AUC, 0,69 (95% confidence interval (CI) 0,600,77), p=0,0002, sensitivity 85%, specificity 42%). In patients with Lp(a) ³30 mg/dL, the diagnostic value of a neutrophil count >2,9 million/mL for diffuse stenosis was higher (AUC, 0,74 (95% CI 0,60-0,86), p= 0,005, sensitivity 90%, specificity 48%). According to logistic regression analysis with the introduction of neutrophils and conventional risk factors (age, body mass index, hypertension and smoking) into the model, only the number of neutrophils above the threshold level remained an independent factor in diffuse coronary stenosis. Lp(a) can induce neutrophil activation, detected by increased CD66b overexpression in whole blood, as well as the formation of neutrophil extracellular traps in primary cell culture.Conclusion. Neutrophil granulocytes can participate in the formation of diffuse atherosclerotic coronary lesions. One of the neutrophil activators may be Lp(a). The combination of high neutrophil count and Lp(a) level in the blood increases the risk of diffuse coronary atherosclerosis.
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来源期刊
Russian Journal of Cardiology
Russian Journal of Cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
2.20
自引率
0.00%
发文量
185
审稿时长
1 months
期刊介绍: Russian Journal of Cardiology has been issued since 1996. The language of this publication is Russian, with tables of contents and abstracts of all articles presented in English as well. Editor-in-Chief: Prof. Eugene V.Shlyakhto, President of the Russian Society of Cardiology. The aim of the journal is both scientific and practical, also with referring to organizing matters of the Society. The best of all cardiologic research in Russia is submitted to the Journal. Moreover, it contains useful tips and clinical examples for practicing cardiologists. Journal is peer-reviewed, with multi-stage editing. The editorial board is presented by the leading cardiologists from different cities of Russia.
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