冠状动脉疾病(CAD)是全世界发病率和死亡率的主要原因。冠状动脉造影可以准确评估动脉粥样硬化冠状动脉狭窄的程度和严重程度。但它几乎没有提供早期发现潜在无症状易损斑块的特征。冠状动脉“脆弱患者”或高风险斑块的识别仍然是CAD治疗中的主要挑战。最近,越来越多的证据表明,DNA损伤在动脉粥样硬化斑块的发生和发展中起作用。细胞分裂阻滞微核(CBMN)测定法是评估染色体损伤和遗传不稳定性的最常用和最有效的方法之一。因此,本系统综述的目的是检索和讨论有关评估MN与经血管造影证实的CAD之间关联的研究的现有文献.2001年至2017年间发表的共8项研究被纳入荟萃分析。尽管研究之间存在很大的异质性(I2=99.7%,p<0.0001),与对照组相比,CAD患者的MN频率总体增加(meta-MR=1.96;95%CI,1.5-3.2,p=0.009).亚组分析显示,两支血管(MR=2.13,95%CI:0.9-6.9,p=0.08)和三支血管疾病(MR=2.89,95%CI:1.84-4.55,P=0.06)的MN形成频率增加。总的来说,这项荟萃分析的结果提供了CBMN与存在之间关联的证据,血管造影评估的CAD的范围和严重程度。然而,分析的论文数量很少,需要进一步的大型和更严格设计的研究,仔细考虑一系列临床混杂因素,比如代谢控制的质量,药物和放射成像治疗的影响。
Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Coronary angiography allows an accurate assessment of the extent and severity of atherosclerotic coronary narrowing, but it provides little characterization of early detection of potentially asymptomatic vulnerable plaque. The identification of the coronary \"vulnerable patient\" or high-risk plaques remains a major challenge in the treatment of CAD. Recently, growing evidence shows that DNA damage plays a role in the initiation and progression of atherosclerotic plaque. Cytokinesis-block micronucleus (CBMN) assay is one of the most frequently used and validated method for assessing chromosomal damage and genetic instability. Accordingly, the purpose of this systematic
review was to retrieve and discuss existing literature on the studies assessing the association between MN and angiographically-proven CAD. A total of 8 studies published between 2001 and 2017 were included in the meta-analysis. Despite a large heterogeneity between studies (I2= 99.7 %, p < 0.0001), an overall increase of MN frequencies was found in patients with CAD compared with control group (meta-MR = 1.96; 95 % CI, 1.5-3.2, p = 0.009). A subgroup analysis showed an increase in the frequency of MN formation for both two- vessel (MR = 2.13, 95 % CI: 0.9-6.9, p = 0.08) and three-vessel disease (MR = 2.89, 95 % CI: 1.84-4.55, P = 0.06). Overall, the results of this meta-analysis provide evidence of an association between CBMN and presence, extent and severity of angiographically-assessed CAD. However, the small number of papers analyzed requires further large and more rigorously designed studies, carefully considering a series of clinical confounding factors, such as the quality of the metabolic control, the influence of drugs and radiation imaging treatments.