Predictors of the progression of immunoglobulin-G4-related abdominal aortic aneurysms after endovascular therapy

F. Kasashima, S. Kasashima, A. Kawashima, Y. Matsumoto, Yoshitaka Yamamoto
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引用次数: 1

Abstract

Objective : Approximately half of inflammatory abdominal aortic aneurysms, defined by the prominent thickening adventitia, are immunoglobulin G4 (IgG4)- related diseases characterized by elevated serum IgG4 and IgG4-positive-plasmacytes infiltration. IgG4-related AAAs (IgG4-AAAs) exhibit vasculitis with elevated inflammatory marker levels. Matrix metalloproteinases (MMPs) degrade the extracellular matrix to destroy the aortic structures to progress aneurysm. This report examined pre- and postoperative serum MMPs and inflammatory marker levels to evaluate the prognosis of IgG4-AAAs after endovascular aortic repair (EVAR). Methods : Among 25 patient with inflammatory abdominal aortic aneurysms (>2-mm-thick periaortic fibrosis) treated with EVAR, IgG4-AAA was diagnosed in 14 patients, and the remaining 11 patients were classified as non-IgG4-AAA. IgG4-AAAs were categorized into cases with increased (IgG4-AAA-up; n = 6) or decreased (IgG4-AAA-down; n=8) postoperative serum IgG4 levels. Before EVAR and after 24 months, we compared the serum MMP, inflammatory marker levels, periaortic fibrosis, and aneurysm diameter. Results : IgG4-AAAs patients showed higher preoperative IL-6 levels, increased postoperative MMP-9 levels, and enlarged postoperative aneurysmal diameters compared with non-IgG4-AAA patients. Among IgG4-AAAs, IgG4-AAA-up exhibited higher preoperative MMP-9, higher preoperative monocytes and eosinophils, increased postoperative MMP-9 and IL-6, and larger aneurysm diameter than IgG4-AAA-down. All patients in IgG4-AAA-down showed shrunk preoperative aneurysm, although almost all patients in IgG4-AAA-up showed enlarged. In IgG4-AAA-up, IgG4/IgG ratio was significantly higher consistently before and after EVAR. MMP-9 was significantly correlated with IgG4 and IL-6. MMP-2 was not significantly different between patients with and without as well as between IgG4-AAA-up and IgG4-AAA-down. Conclusion: Increased postoperative MMP-9 and IL-6 in IgG4-AAA may accelerate aneurysmal progression after EVAR. IgG4-AAA-up exhibited increased IL-6 levels and larger aneurysm diameters following EVAR than IgG4-AAA-down and were considered as the high-risk group with a tendency toward progression. Before surgery, a high IgG4/IgG ratio, high MMP-9 concentrations, a high ratio of monocytes and eosinophils might predict IgG4-AAA-up.
血管内治疗后免疫球蛋白g4相关腹主动脉瘤进展的预测因素
目的:大约一半的炎性腹主动脉瘤是免疫球蛋白G4 (IgG4)相关疾病,其特征是血清IgG4升高和IgG4阳性浆细胞浸润。igg4相关的AAAs (IgG4-AAAs)表现为血管炎,炎症标志物水平升高。基质金属蛋白酶(MMPs)降解细胞外基质,破坏主动脉结构,使动脉瘤发展。本报告检测了术前和术后血清MMPs和炎症标志物水平,以评估血管内主动脉修复(EVAR)后igg4 - aaa的预后。方法:25例经EVAR治疗的炎性腹主动脉瘤(> 2mm厚主动脉周围纤维化)中,14例诊断为IgG4-AAA,其余11例为非IgG4-AAA。将igg4 - aaa分为IgG4-AAA-up;n = 6)或降低(IgG4-AAA-down;n=8)术后血清IgG4水平。在EVAR前和24个月后,我们比较了血清MMP、炎症标志物水平、主动脉周围纤维化和动脉瘤直径。结果:与非igg4 - aaa患者相比,igg4 - aaa患者术前IL-6水平升高,术后MMP-9水平升高,术后动脉瘤直径增大。在igg4 - aaa组中,IgG4-AAA-up组术前MMP-9增高,术前单核细胞和嗜酸性粒细胞增高,术后MMP-9和IL-6增高,动脉瘤直径比IgG4-AAA-down组大。IgG4-AAA-down组术前动脉瘤均缩小,而IgG4-AAA-up组术前动脉瘤几乎均增大。在IgG4- aaa -up组,IgG4/IgG比值在EVAR前后均显著升高。MMP-9与IgG4、IL-6显著相关。MMP-2在igg4 - aaa升高与不升高、igg4 - aaa降低患者之间无显著差异。结论:术后IgG4-AAA中MMP-9和IL-6的升高可能加速EVAR后动脉瘤的进展。与IgG4-AAA-down组相比,IgG4-AAA-up组EVAR后IL-6水平升高,动脉瘤直径增大,有进展趋势,属于高危组。术前,高IgG4/IgG比值、高MMP-9浓度、高单核细胞和嗜酸性粒细胞比值可能预示IgG4- aaa升高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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