Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes
Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes
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DOI：
10.1161/01.cir.0000090690.67322.51
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发表时间：
2003-09-23
期刊：
影响因子：
37.8
通讯作者：
Hamm, CW
中科院分区：
文献类型：
--
作者：
Baldus, S;Heeschen, C;Hamm, CW
多形核中性粒细胞（PMNs）作为急性冠脉综合征（ACS）的重要介质已引起人们的关注。髓过氧化物酶（MPO）是一种由pmn大量表达并在激活过程中分泌的血红蛋白，具有强效的促炎特性，可能直接导致组织损伤。然而，MPO是否也能提供ACS患者的预后信息仍然未知。方法与结果：测定1090例ACS患者血清mpo水平。在6个月的随访中，我们记录了死亡和心肌梗死。MPO水平与肌钙蛋白T、可溶性CD40配体或c反应蛋白水平或st段变化无关。然而，MPO水平升高的患者（bb0 350马克杯/升；31.3%）的心脏风险明显增加（校正风险比[HR] 2.25[1.32至3.82]；P=0.003）。特别是，MPO血清水平识别肌钙蛋白T水平低于0.01马克杯/升的高危患者（调整后危险度为7.48 [95% CI 1.98至28.29]；P=0.001）。在包含其他生化指标的多变量模型中，肌钙蛋白T （HR 1.99， P=0.023）、c反应蛋白（HR 1.25， P=0.044）、血管内皮生长因子（HR 1.87， P=0.041）、可溶性CD40配体（HR 2.78, P < 0.001）和MPO （HR 2.11， P=0.008）都是患者6个月预后的独立预测因子。结论：在ACS患者中，MPO血清水平有力地预测了随后心血管事件的风险增加，并扩展了从传统生化标志物获得的预后信息。鉴于其促炎特性，MPO可能同时作为血管炎症的标志物和介质，并进一步指出PMN激活在ACS病理生理中的重要性。
Background-Polymorphonuclear neutrophils (PMNs) have gained attention as critical mediators of acute coronary syndromes (ACS). Myeloperoxidase (MPO), a hemoprotein abundantly expressed by PMNs and secreted during activation, possesses potent proinflammatory properties and may contribute directly to tissue injury. However, whether MPO also provides prognostic information in patients with ACS remains unknown.Methods and Results-MPO serum levels were assessed in 1090 patients with ACS. We recorded death and myocardial infarctions during 6 months of follow-up. MPO levels did not correlate with troponin T, soluble CD40 ligand, or C-reactive protein levels or with ST-segment changes. However, patients with elevated MPO levels (>350 mug/L; 31.3%) experienced a markedly increased cardiac risk (adjusted hazard ratio [HR] 2.25 [1.32 to 3.82]; P=0.003). In particular, MPO serum levels identified patients at risk who had troponin T levels below 0.01 mug/L (adjusted HR 7.48 [95% CI 1.98 to 28.29]; P=0.001). In a multivariate model that included other biochemical markers, troponin T (HR 1.99; P=0.023), C-reactive protein (1.25; P=0.044), vascular endothelial growth factor ( HR 1.87; P=0.041), soluble CD40 ligand (HR 2.78; P < 0.001), and MPO (HR 2.11; P=0.008) were all independent predictors of the patient's 6-month outcome.Conclusions-In patients with ACS, MPO serum levels powerfully predict an increased risk for subsequent cardiovascular events and extend the prognostic information gained from traditional biochemical markers. Given its proinflammatory properties, MPO may serve as both a marker and mediator of vascular inflammation and further points toward the significance of PMN activation in the pathophysiology of ACS.