Inflammatory markers in peripheral arterial disease patients after endovascular revascularization with new restenosis. [Parametry stanu zapalnego u chorych na miażdżycę tętnic kończyn dolnych po obwodowej, wewnątrznaczyniowej rewaskularyzacji i po powstaniu restenozy]

Abstract

Introduction. Inflammation plays a central role in the pathophysiology and progression of atherosclerosis, also in patients with peripheral arterial disease (PAD). Revascularization is a risk factor which intensifies this process sometimes leading to newly developed restenosis.Aim. To determine the levels of fibrinogen, C-reactive protein (CRP), interleukin 6 (IL-6), interleukin 10 (IL-10), basic fibroblast growth factor (bFGF) and transforming growth factor-beta 1 (TGF-b1) in the blood of patients with PAD after endovascular revascularization of lower limbs and in patients with new restenosis.Material and methods. The study included 150 patients with PAD (90 men and 60 women), aged 50–88 (mean 65.5) years after successful peripheral angioplasty (PTA) and/or stenting. Within 12 months after revascularization procedure in 38 PAD patients restenosis occurred. Control group for cytokines consisted of 15 clinically healthy subjects without limb ischaemia aged 60–83 years. Fasting blood was drawn in the morning and put into 3.2% sodium citrate in a 9:1 proportion (for determination of fibrinogen and CRP), and 2.6 ml of blood was mixed with EDTA for determination of cytokines: IL-6, IL-10, bFGF and TGF-b1. All parameters were measured in the plasma of patients with commercial kits for enzyme immunoassay; fibrinogen and CRP levels were measured with coagulometer.Results. In the plasma of patients with PAD after revascularization, the levels of fibrinogen and CRP were significantly higher than in controls. These markers increased within 12 months of observation: CRP level increased almost two-fold and fibrinogen only by about 10%. All examined cytokines in PAD patients with restenosis were higher than in those without restenosis, but the difference was significant only for IL-10 and bFGF. But increased cytokines in patients with restenosis were within the laboratory norms specified by reagent producers except of TGF-b1.

 Conclusions.

1. In PAD patients after endovascular revascularization the levels of CRP and fibrinogen during one year observation significantly increased.
2. In these patients, significant correlation was observed between pro-inflammatory CRP and anti-inflam- matory IL-10.
3. The concentrations of CRP, fibrinogen and cytokines (IL-6, bFGF, TGF-b1 and IL-10) were also higher in PAD patients with restenosis indicating the involvement of low-grade inflammation in this process.