本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMoa2309822

摘要内容如下：

背景

在临床前研究中，微塑料和纳米塑料（MNPs）正在成为心血管疾病的潜在危险因素。这种风险延伸到人类的直接证据是缺乏的。

方法

我们进行了一项前瞻性、多中心、观察性研究，纳入了因无症状性颈动脉疾病而接受颈动脉内膜切除术的患者。使用热解-气相色谱-质谱、稳定同位素分析和电子显微镜分析切除的颈动脉斑块样本中MNPs的存在。采用酶联免疫吸附试验和免疫组织化学方法检测炎症标志物。主要终点是在斑块中有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名患者参加了该研究，其中257名患者完成了平均（±SD）33.7±6.9个月的随访。150名患者（58.4%）在颈动脉斑块中检测到聚乙烯，平均水平为21.7±24.5μg/mg斑块；31名患者（12.1%）也有可测量的聚氯乙烯含量，平均水平为每毫克斑块5.2±2.4μg。电子显微镜显示，斑块巨噬细胞中可见锯齿状边缘的异物颗粒，并分散在外部碎片中。射线照相检查显示，其中一些颗粒含有氯。在动脉粥样硬化中检测到MNPs的患者比未检测到这些物质的患者发生主要终点事件的风险更高（风险比为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，检测到MNPs的颈动脉斑块患者比未检测到MNPs的患者具有更高的心肌梗死、中风或任何原因死亡的复合风险。（由Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale和其他机构资助；ClinicalTrials.gov编号，NCT05900947。）

英文原文如下：

Abstracts

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.).

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