冠状动脉斑块形态学与血浆炎症介质的关系  

Associations between the plasma inflammatory markers and plaque morphologies of coronary artery lesions

作　　者：王显[1] 胡大一[1] 杨士伟[1] 张健[1] 谭琛[1] 张守彦[1] 

机构地区：[1]北京军区总医院心脏中心,100700

出　　处：《中华内科杂志》2008年第1期27-30,共4页Chinese Journal of Internal Medicine

摘　　要：目的从冠状动脉（冠脉）斑块的影像学、血浆炎症介质水平等方面综合评价冠脉斑块易损性。方法将冠脉造影显示为单支病变的58例患者，按造影结果分为Ⅰ型病变组（16例）、Ⅱ型病变组（25例）、Ⅲ型病变组（17例）及对照组（17例）。其中行血管内超声（IVUS）检查的28例患者分为急性冠脉综合征（ACS）组和稳定性心绞痛组2个亚组。采用酶联免疫吸附法测定血浆高敏C反应蛋白（hs-CRP）、金属基质蛋白酶（MMP，包括MMP-2、MMP-9）、CD40配体（CD40L）和妊娠相关蛋白-A（PAPP—A）水平。结果Ⅱ型病变组血浆MMP-2、MMP-9和PAPP—A水平显著高于Ⅰ型病变组（P〈0．05）、Ⅲ型病变组（P〈0．05）和对照组（P〈0．001）；线性相关分析显示，Ⅱ型病变组hs—CRP与MMP-2显著正相关（r=0．508）；MMP-2与MMP-9、CD40L、PAPP—A显著正相关（r=0．647、0．704、0．751）；MMP-9与CD40L、PAPP—A显著正相关（r=0．491、0．639）；CD40L与PAPP—A（r=0．896）显著正相关。IVUS亚组分析表明，ACS组的“罪犯”病变斑块面积、斑块负荷、高危斑块发生率、重构指数和正重构均显著大于对照组（P=0．000、0．037、0．028、0．015和0．040）；ACS组血浆hs—CRP、MMP-2、MMP-9和PAPP-A水平也显著升高（P：0．033、0．000、0．000和0．027）。结论冠脉造影、IVUS检查结合检测血浆炎症介质水平更有助于判断冠脉斑块的易损性。Objective To evaluate the vulnerability of coronary artery plaque with coronary angiography（CAG）, intravascular ultrasound （IVUS） and the levels of plasma inflammatory markers. Methods 58 consecutive patients with lesion of a single blood vessel demonstrated successfully by CAG were randomly divided into 3 groups based on the angiographic morphology of the the lesions ： type Ⅰ lesion group （n = 16）, type Ⅱ lesion group （n =25）, typeⅢ lesion group （n = 17）. Meantime, a control group of stable angina （n = 17） was established. A subgroup of 28 patients （including 18 acute coonary sysdrome （ACS） patients and 10 stable angina control patients） who underwent IVUS study were analyzed. Then the plasma levels of high sensitivity CRP （ hs-CRP）, matrix metalloproteinase （ MMP, including MMP-2 and MMP-9）, CD40 ligand （CD40L） and pregnancy associated plasma protein-A （PAPP-A） were measured with ELISA. Analyses were performed by statistical package SPSS 11.0. Results The plasma levels of MMP-2, MMP-9 and PAPP-A in type Ⅱ lesion group were significantly higher than the other groups （P 〈 0. 05, 0. 05, 0. 001, respectively）. In type Ⅱ lesion group, linear correlation analysis manifested significantly positive correlation between levels of hs-CRP and MMP-2 （ r = 0. 508 ） ; MMP-2 and MMP-9, CD40 L, PAPP-A （ r = 0. 647,0. 704,0. 751, respectively） ; MMP-9 and CD40L, PAPP-A （ r = 0. 491,0. 639, respectively） ; CD40L and PAPP-A （ r = 0. 896）. IVUS subgroup analysis showed that the area of plaques and plaques burden in culprit lesion, the incidence of high-risk plaques,remodeling index （RI） and positive remodeling percentage in ACS patients were significantly greater than those in the control group （P = 0. 000,0. 037,0. 028, 0. 015, 0. 040, respectively）. Compared with the control group,the plasma levels of hs-CRP, MMP-2, MMP-9 and PAPP-A were markedly elevated （ P = 0. 033, 0. 000,0. 000,0. 027, respectively）. Conclusions CAG and IVUS combine

关 键 词：冠状动脉 冠状血管造影术 炎症介导素类 

分 类 号：R686[医药卫生—骨科学]