冠状动脉重构的血管内超声研究及基质金属蛋白酶和高敏C反应蛋白检测  

Intravascular ultrasound study of coronary remodeling and determination of matrix metalloproteinase and hypersensitive C-reactive protein

作　　者：惠波[1] 党群[2] 王小飞[2] 金喆[2] 夏大胜[2] 高陆[2] 蔡林[2] 张靖[2] 徐芳[2] 王佩显[1] 

机构地区：[1]天津医科大学总医院心内科,300052 [2]天津市第一中心医院心内科

出　　处：《中华心血管病杂志》2005年第5期428-432,共5页Chinese Journal of Cardiology

摘　　要：目的用血管内超声(IVUS)对比研究不同类型冠心病患者的冠状动脉重构(remodeling)特点,探讨冠状动脉重构与临床表现、基质金属蛋白酶(MMPs)及高敏C反应蛋白(hs CRP)的关系。方法在行冠状动脉介入治疗前,应用IVUS研究38例急性冠状动脉综合征(ACS)和18例稳定性心绞痛(SA)患者,测量“罪犯”血管病变处及其近端、远端参考段的外弹力膜(EEM)面积、管腔面积,计算斑块面积和重构指数(RI),定义RI>1.05为正重构,RI<0.95为负重构。识别出高危斑块,检测外周血基质金属蛋白酶2(MMP2)、基质金属蛋白酶9(MMP9)和hs CRP水平。结果ACS组“罪犯”血管处的斑块面积大于SA组[(11.94±4.90)mm2比(9.17±3.36)mm2,P=0.035]。ACS组RI明显大于SA组(0.972±0.222比0.796±0.130,P=0.003)。两组正、负重构分布比率显著不同正重构在ACS组比SA组更常见(34.2%比5.6%,P=0.047),而负重构在SA组更常见(负重构在ACS组和SA组分别为52.6%与88.9%,P=0.003)。ACS组高危斑块发生率多于SA组(76.3%比50.0%,P=0.040)。ACS组患者血清MMP2高于SA组[(250.65±47.97)μg/L比(214.21±47.20)μg/L,P=0.029],前者的血浆MMP9也高于后者[(84.26±9.78)μg/L比(68.46±22.82)μg/L,P=0.038],前者的血清hs CRP亦高于后者[(3.62±3.37)mg/L比(1.48±1.52)ObjectiveTo investigate remodeling characteristics of coronary lesions in patients with acute coronary syndromes (ACS) versus stable angina pectoris (SA) using intravascular ultrasound (IVUS), and to explore the relationship between arterial remodeling and clinical presentation or matrix metalloproteinase (MMPs) or hyper-sensitive C-reactive protein (hs-CRP). Methods We studied culprit lesions of 38 patients with ACS and 18 patients with SA using IVUS before coronary intervention. The lesion site and a proximal or distal reference site including the external elastic membrane (EEM) area and lumen area were analyzed. Plaque area and remodeling index (RI) were calculated, and directions of arterial remodeling were determined. Positive remodeling was defined as RI>1.05 and negative remodeling as RI<0.95. We analyzed the culprit lesion qualitatively, identified high risk plaque and compared them in each group. The blood level of MMP-2、MMP-9 and hs-CRP in each group were also determined.ResultsThe plaque area at culprit lesions in patients with ACS was significantly larger (11.94±4.90 versus 9.17±3.36mm2;P=0.035), and also the RI in ACS group was significantly greater than that of patients with SA (0.972±0.222 versus 0.796±0.130;P=0.003).The distribution of remodeling in these two groups was different: positive remodeling was more frequent in ACS group than in SA group (34.2% versus 5.6%, P=0.047), whereas negative remodeling was more frequent in SA group (52.6% versus 88.9%, P=0.003). There was higher incidence of high risk plaque in ACS group compared to SA (76.3% versus 50.0%, ~P= 0.040). The level of serum MMP-2 in ACS group was higher than that of SA group (250.65±47.97 μg/L versus 214.21±47.20 μg/L, P=0.029). The same applied for plasma MMP-9 (84.26±9.78 μg/L versus 68.46±22.82 μg/L, P=0.038) and serum hs-CRP (3.62±3.37 mg/L versus 1.48±1.52 mg/L, P=0.041). Conclusions Positive remodeling, larger plaque area and higher incidence of high risk plaque are associated with ACS, whereas negative remodel

关 键 词：冠状动脉重构 基质金属蛋白酶-2(MMP-2) 基质金属蛋白酶-9(MMP-9) 蛋白检测 超声研究 急性冠状动脉综合征 hs-CRP 高敏C反应蛋白 血清MMP-2 斑块发生率 稳定性心绞痛 斑块面积 “罪犯”血管 ACS 临床表现 冠心病患者 血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病] R73-362[医药卫生—内科学]