动脉粥样硬化和心血管事件中的微塑料和纳米塑料。
Microplastics and Nanoplastics in Atheromas and Cardiovascular Events.
机构信息
From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.).
出版信息
N Engl J Med. 2024 Mar 7;390(10):900-910. doi: 10.1056/NEJMoa2309822.
BACKGROUND
Microplastics and nanoplastics (MNPs) are emerging as a potential risk factor for cardiovascular disease in preclinical studies. Direct evidence that this risk extends to humans is lacking.
METHODS
We conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens were analyzed for the presence of MNPs with the use of pyrolysis-gas chromatography-mass spectrometry, stable isotope analysis, and electron microscopy. Inflammatory biomarkers were assessed with enzyme-linked immunosorbent assay and immunohistochemical assay. The primary end point was a composite of myocardial infarction, stroke, or death from any cause among patients who had evidence of MNPs in plaque as compared with patients with plaque that showed no evidence of MNPs.
RESULTS
A total of 304 patients were enrolled in the study, and 257 completed a mean (±SD) follow-up of 33.7±6.9 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4%), with a mean level of 21.7±24.5 μg per milligram of plaque; 31 patients (12.1%) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2±2.4 μg per milligram of plaque. Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris. Radiographic examination showed that some of these particles included chlorine. Patients in whom MNPs were detected within the atheroma were at higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27; P<0.001).
CONCLUSIONS
In this study, patients with carotid artery plaque in which MNPs were detected had a higher risk of a composite of myocardial infarction, stroke, or death from any cause at 34 months of follow-up than those in whom MNPs were not detected. (Funded by Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale and others; ClinicalTrials.gov number, NCT05900947.).
背景
在临床前研究中，微塑料和纳米塑料（MNPs）已成为心血管疾病的潜在风险因素。直接证据表明这种风险延伸到人类。
方法
我们进行了一项前瞻性、多中心、观察性研究，涉及因无症状颈动脉疾病而行颈动脉内膜切除术的患者。使用热裂解气相色谱-质谱法、稳定同位素分析和电子显微镜分析切除的颈动脉斑块标本中 MNPs 的存在。通过酶联免疫吸附试验和免疫组织化学检测评估炎症生物标志物。主要终点是斑块中有 MNPs 证据的患者与斑块中无 MNPs 证据的患者相比，心肌梗死、中风或任何原因导致的死亡的复合终点。
结果
共有 304 名患者入组研究，257 名患者平均（±SD）随访 33.7±6.9 个月。150 名患者（58.4%）的颈动脉斑块中检测到聚乙烯，平均每毫克斑块 21.7±24.5μg；31 名患者（12.1%）也可测量到一定量的聚氯乙烯，平均每毫克斑块 5.2±2.4μg。电子显微镜显示斑块巨噬细胞中存在可见的锯齿状边缘的外来颗粒，并散在外部碎屑中。放射检查显示，这些颗粒中的一些含有氯。在动脉粥样硬化中检测到 MNPs 的患者发生主要终点事件的风险高于未检测到这些物质的患者（风险比，4.53；95%置信区间，2.00 至 10.27；P<0.001）。
结论
在这项研究中，在 34 个月的随访中，在颈动脉斑块中检测到 MNPs 的患者发生心肌梗死、中风或任何原因导致的死亡的复合终点的风险高于未检测到 MNPs 的患者。（由 Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale 等资助；ClinicalTrials.gov 编号，NCT05900947）。
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