冠状动脉血管重塑与脂代谢异常及斑块稳定性关系的初探  

Preliminary Discussion of the Relationship between Coronary Vessel Remodeling and Dyslipidemia and Plaque Stability

作　　者：金喆[1] 李敬伟[2] 康宁[3] 党群[1] 

机构地区：[1]天津市南开医院心血管内科,300100 [2]天津市第一中心医院心血管内科 [3]中国医学科学院基础医学研究所北京协和医学院基础学院免疫学系

出　　处：《天津医药》2010年第10期852-855,共4页Tianjin Medical Journal

摘　　要：目的:以血管内超声法评价冠状动脉代偿性扩张与脂代谢异常及斑块性质之间的关系,并探讨血管重塑的可能机制。方法:将冠状动脉造影确定为单支局限性病变的56例患者,分为代偿性扩张组(30例)和无代偿性扩张组(26例)。对冠状动脉重塑指数和血脂成分做相关性分析,并对2组间血脂水平、超敏C反应蛋白(hs-CRP)、白介素(IL)-6、内皮素(ET)-1和不同斑块性质分布进行对比分析。结果:与无代偿性扩张组相比,代偿性扩张组患者血清低密度脂蛋白胆固醇(LDL-C)明显增高,高密度脂蛋白胆固醇水平(HDL-C)明显降低(P<0.05或P<0.01),重塑指数与总胆固醇(TC)、LDL-C呈正相关,而与HDL-C呈负相关,差异均有统计学意义(P<0.05)。代偿性扩张组炎性指标较高,出现偏心性软斑块的概率较高,无代偿性扩张组内皮素水平较高,更易出现斑块钙化。结论:血管重塑与脂代谢异常以及病变部位斑块性质密切相关。炎症反应和内皮功能紊乱引起的内皮素分泌失衡也可能是血管重塑的机制。Objective：To explore the relationship between dyslipidemia,plaque characteristics and coronary artery compensatory enlargement,and the possible mechanisms of vessel remodeling thereof.Methods：Fifty-six patients with local lesion within single coronary segment were selected and divided into two groups,compensatory enlargement group（30 patients） and non-compensatory enlargement group（26 patients）.The correlation between remodeling index and blood lipid composition was analyzed.The values of blood lipid level,hypersensitive C reactive protein,interleukin-6,endothelin,and plaque distribution was a also compared between the two groups.Results：Compared with the non-compensatory enlargement group,there was a significantly higher serum low density lipoprotein cholesterol [（2.86±0.43） mmol/L vs（2.59±0.57） mmol/L,P 0.05],whereas a lower serum high density lipoprotein cholesterol [（1.29±0.25） mmol/L vs（1.51±0.29） mmol/L,P 0.01] in patients with compensatory enlargement.There was a positive correlation between the remodeling index and total cholesterol,and between the remodeling index and low density lipoprotein cholesterol.However,a negative correlation existed between the remodeling index and high density lipoprotein cholesterol.In addition,the patients of compensatory enlargement group had higher levels of inflammatory markers and higher incidence of eccentric,soft plague.The patients of non-compensatory enlargement group had a higher endothelin level and tended to have the calcified plague.Conclusion：Coronary vessel remodeling was closely related to dyslipidemia and plaque characteristics.The inflammatory response and endothelin imbalance resulted from endothelium dysfunction might also be the mechanisms of vessel remodeling.

关 键 词：心绞痛 冠状血管造影术 超声检查 介入性 血管舒张 脂类 C反应蛋白质 白细胞介素6 内皮缩血管肽1 

分 类 号：R541.4[医药卫生—心血管疾病]