急性冠状动脉综合征血管内超声斑块显像特征与血浆同型半胱氨酸水平的相关性研究  

An correlated research about plaque image characteristics of intravascular ultrasound and the plasma levels of homocysteine in acute coronary syndrome

作　　者：徐会圃[1] 刘长梅[1] 王青海[1] 刘现亮[1] 张明哲[2] 王东[1] 李宗清[1] 李景森[1] 程艳丽[1] 张静[1] 

机构地区：[1]山东滨州医学院附属医院心内科,山东滨州256603 [2]山东胜利油田中心医院心内科

出　　处：《临床心血管病杂志》2009年第7期528-531,共4页Journal of Clinical Cardiology

基　　金：山东省优秀中青年科学家科研奖励基金(No:2006BS03069)

摘　　要：目的:探讨急性冠状动脉综合征(ACS)斑块稳定性与血浆同型半胱氨酸(Hcy)水平的相关性,寻找不稳定斑块的危险因素。方法:对49例ACS患者和35例稳定型心绞痛(SAP)患者"罪犯"冠状动脉进行血管内超声(IVUS)检查,同时测定外周血浆Hcy水平。结果:ACS组Hcy水平明显高于SAP组(P<0.05);ACS组患者冠状动脉病变处以软斑块为主69.4%(34/49),SAP患者冠状动脉病变处以硬斑块为主77.1%(27/35),差异有统计学意义(P<0.05)。与SAP比较,ACS组不稳定斑块和内膜破裂,血栓形成病变占比例明显增高(P<0.01);ACS组病变处斑块面积大(P<0.01),斑块负荷重(P<0.01),以偏心斑块(P=0.000)和正性重构为(P=0.002)主。Hcy水平、斑块面积、狭窄率、斑块负荷、偏心指数均可影响斑块的稳定性。Logistic回归分析显示Hcy与斑块不稳定相关。结论:Hcy可能是ACS斑块不稳定的相关因素,可作为预测斑块不稳定的指标。Objective：To investigate the relationship between plasma level of homocysteine and the stability of plaque. And to seek the risk factors of the vulnerable plaque. Methods：Thirty-five patients with stable angina peetoris （SAP） and forty-nine patients with Acute coronary syndrome （ACS） （included acute myocardial infarction and unstable peetoris） were examined by intravascular ultrasound （IVUS）. Result：Compared with SAP group,the plasma levels of homocysteine were higher in ACS group（20.57±4.19 vs 16.74±3.15） μmol/L （ P〈0. 05） . Soft plaques were dominant in ACS patients [69.4%, 34/49], and hard plaques were dominant in SAP patients[ 77.1 % （27 /35） ]（P〈0.05）. Also, plaque area, plaque burden and eccentricity index were all significantly larger in ACS patients than those of SA patients （ all P〈0.05） . Positive remodeling was more frequent in ACS patients than in SAP patients, whereas negative remodeling was more frequent in SAP patients （ P〈0. 05）. Plasma homocysteine levels, plaque area, plaque burden, eccentricity index could affect the stability of plaque. Logistic regression analysis showed that homocysteine were correlated to the vulnerable plaque. Conclusion; Homocysteine could be a correlation factor of the plaque stability in the ACS, which could be an important index to predict the ACS.

关 键 词：急性冠状动脉综合征 半胱氨酸 冠状动脉粥样硬化 心绞痛 不稳定型 超声检查 介入性 

分 类 号：R541.4[医药卫生—心血管疾病]