급성 심근경색증에서 염증반응과 혈소판 활성화의 기원 = The Source of Inflammatory Response and Platelet Activation inPatients with Acute Myocardial Infarction

다국어 초록 (Multilingual Abstract)

Background and Objectives ：Studies on the stability of atheromatous plaques, as a determinant of the cause of compli -cations, have been reported. Among the functional features of plaques related with vulnerability, inflammation has emerged as a leading cause of clinical presentation. The purpose of this study was to find the source of the inflam -matory response in the patients with acute myocardial infarction (AMI). Subjects and Methods ：Patients with AMI, whose lesion of in either the left anterior descending artery (LAD group, n= 13) or the right coronary artery (RCA group, n= 11), were selected. The levels of interleukin -6 (IL -6) and P -selectin were measured in blood from the aortic rot (A), great cardiac vein (G) and peripheral vein (V). The control group (n= 15) included patients with either stable or variant angina. Results：The levels of IL -6 were 4.77 ± 6.0 (A), 11.32± 7.8 (G) and 4.39 ± 5.0 pg/mL (V) in the LAD group, and 3.64 ± 2.1 (A), 6.05± 4.9 (G) and 3.84 ± 3.2 pg/mL (V) in the RCA group. Unrelated to the infarction related artery, the level of IL -6 in the great cardiac vein was significantly increased in patients with AMI. The percentages of platelet expressed P -selectin were 6.03 ± 7.0 (A), 8.14± 8.1 (G) and 8.83 ± 7.9 (V) in the LAD group and 6.46 ± 8.4 (A), 5.80± 6.0 (G) and 5.9 1± 6.9 (V) in the RCA group. Conclusion ：These findings sugest that the generalized inflammatory response is Therefore, systemic therapy, as well as local management for vulnerable plaque, would be required.

국문 초록 (Abstract)

배경 및 목적：죽상동맥 경화반의 안정도가 허혈성 심질환의 경과를 결정하는데 염증반응은 죽상동맥경화의 시작과 파열에 따르는 합병증 등에 영향을 미친다. 전신 염증반응은 급성관동
맥 증후군에서 증가되는데, 기원에 대해서는 확립되어 있지않다. 본 연구는 급성 심근경색 환자를 대상으로 염증반응 부위와 경색관련 혈관과의 관련성을 비교하여 염증반응의 기원에 대해서 알아보고자 하였으며, 혈소판 활성화를 함께 측정하였다.
방 법：
우관상동맥(RCA, n=11) 또는 좌전하행지동맥(LAD, n=13)이 병변인 급성심근경색 환자를 대상으로 대동맥기시부(A),큰심장정맥(G), 말초정맥(V)에서 동시에 혈액을 채취하여 ELISA방법으로 Interleukin-6(IL-6)를 측정하고, 혈소판활성화 정도는 P-selectin의 발현 정도를 flow cytometry 방법으로 파악하여 비교하였다. 대조군(n=15)은 LAD에 협착병변이 있는 안정형 협심증 환자와 LAD에서 혈관경련이 증명된 변이형 협심증 환자였다.결 과：IL-6 측정치는 LAD군에서 4.77±6.0 pg/mL(A), 11.32 ±7.8 pg/mL(G), 4.39±5.0 pg/mL(V)이고, RCA군에서는 3.64±2.1 pg/mL(A), 6.05±4.9 pg/mL(G), 3.84±3.2 pg/mL(V)로 병변혈관 위치에 상관 없이 큰심장정맥에서 증가되었다(generalized transcoronary gradient). P-selectin 은 LAD군의 경우6.03±7.0%(A), 8.14±8.1%(G), 8.83±7.9%(V)로 큰심장정맥에서 유의하게 증가되었으나(selective transcoronary gradient) RCA군과 대조군에서는 3곳에서의 측정값이 유사하였다.
결 론：
급성 심근경색증에서 증가된 염증반응은 경색관련 혈관과는 상관없이 관상동맥 순환계 내에서 광범위하게 관찰된다. 파손된 죽상반이 혈전형성을 동반하여 심근경색까지 발생시킬 것인지는 죽상반의 혈전형성 경향에 의해 결정된다. 따라서 불안정 죽상반에 대한 전신적 치료와 국소치료는 병행되어야 할 것이라 생각된다.

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