冠心病患者冠状动脉重构效应初步探讨  

Initial Study on Coronary Arterial Remodeling of Patients with Coronary Artery Disease

作　　者：王显[1] 胡大一[1] 沙鸥[1] 赵怀兵[1] 

机构地区：[1]北京军区总医院心血管内科,北京市100700

出　　处：《中国康复理论与实践》2008年第8期748-750,共3页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的使用血管内超声(IVUS)初步探讨冠心病患者的冠状动脉重构效应。方法28例行IVUS检查的冠心病患者随机分为急性冠脉综合征(ACS)组(18例)和稳定性心绞痛组(对照组,10例),分别测定两组患者的斑块面积、血管外弹力膜(EEM)面积、斑块负荷、重构指数(RI)等指标,同时采用酶联免疫吸附法测定患者血浆高敏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ACS组患者的"罪犯"病变斑块面积(P=0.000)、EEM面积(P=0.003)和斑块负荷(P=0.037)均大于对照组,高危斑块发生率(P=0.028)和RI(P=0.015)也升高。正重构多见于ACS组(P=0.040),负重构多见于对照组(P=0.039)。高危斑块组患者的血浆MMP-2(P=0.011)、MMP-9(P=0.001)和CD40L(P=0.034)水平高于非高危斑块组。与负重构组和无重构组比较,正重构组血浆hs-CRP(P=0.190)、MMP-2(P=0.255)、MMP-9(P=0.574)、CD40L(P=0.342)和PAPP-A(P=0.403)水平,以及高危斑块发生率(P=0.566)等均无显著性差异。以RI为因变量、以分组和炎症介质水平等为自变量的回归方程为RI=0.179-0.131group(group代表分组),其中分组变量的回归系数具有显著性意义(P<0.05)。结论冠心病的表现类型可能是预测冠状动脉重构的独立变量。Objective To initially evaluate the coronary arterial remodeling of the patients with coronary artery disease by use of intravascular unltrasound（IVUS）.Methods 28 consecutive patients with coronary artery disease were randomly divided into the acute coronary syndrome（ACS）group（n=18）and stable angina group（n=10）.The area of plaques,the area of extra-elasticity membrane（EEM）of vascellum and plaque burden as well as remodeling index（RI）of coronary arteries were measured by IVUS in two groups.The plasma levels of high sensitivity C-reactive protein（hs-CRP）,matrix metalloproteinase（MMP,including MMP-2 and MMP-9）,CD40 ligand（CD40L）and pregnancy associated plasma protein-A（PAPP-A）were measured by ELISA.Results The area of plaques（P=0.000）,the area of EEM（P=0.003）and plaque burden of ＂criminal＂ lesions（P=0.037）in the patients of the ACS group increased more significantly than that of the control group.The incidence of high-risk plaques（P=0.028）and RI（P=0.015）in the ACS group increased more significantly than that of the control group.The positive remodeling was more common in the ACS group（P=0.040）,while negative remodeling in the control group（P=0.039）.The plasma levels of MMP-2（P=0.011）,MMP-9（P=0.001）and CD40L（P=0.034）in the high-risk plaques group were significantly higher than those in the non-high-risk plaques group.There were no significant differences of the plasma levels of hs-CRP（P=0.190）,MMP-2（P=0.255）,MMP-9（P=0.574）,CD40L（P=0.342）,PPAP-A（P=0.403）and the incidence of high-risk plaques（P=0.566）in the positive and negative as well as none remodeling groups.Regression analysis showed that only the regression coefficient of ACS and stable angina by RI were significant（P〈0.05）,the regression equation was RI=0.179-0.131 group（group stands for ACS group and stable angina group）.Conclusion The clinical types of coronary artery disease may be an independent predictor of the coronary arterial remodeling m

关 键 词：冠心病 冠状动脉重构 血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病]