炎症因子及血管内超声检查对冠心病患者预后的评估作用  

Prognostic value of plasma inflammatory factors and coronary arterial culprit lesions in patients with coronary artery disease

作　　者：杨建敏[1] 张邢炜[2] 王宁夫[1] 高炎[1] 李佩璋[1] 周亮[1] 叶显华[1] 徐坚[1] 潘浩[1] 童国新[1] 

机构地区：[1]杭州市第一人民医院心内科,310006 [2]杭州师范大学附属医院心内科

出　　处：《浙江医学》2011年第2期161-163,共3页Zhejiang Medical Journal

基　　金：浙江省卫生厅科研项目（2004A075）;杭州市科技局重点专科项目（2004433Q06）

摘　　要：目的研究超敏C反应蛋白（hs—CRP）等炎症因子和斑块血管内超声指标对冠心病患者预后的评估作用。方法选取急性冠状动脉综合征（ACS）患者89例（ACS组）、稳定性心绞痛（SA）患者72例（SA组），分别测量并比较两组患者的血管外弹力膜面积（EEMCSA）、最小管腔面积（MLA）、斑块负荷、脂核负荷、斑块纤维帽厚度、重构指数、斑块破裂情况、血栓等；应用ELISA法检测并比较两组患者血浆hs—CRP和基质金属蛋白酶前体1（proMMP-1）的浓度；随访1年观察主要心脏不良事件（MACE，包括死亡、急性心肌梗死以及各种血管重建等）的发生情况。结果较之SA组，ACS组患者病变斑块表现为EEMCSA、斑块负荷、脂核负荷更大、正性重构更多以及MLA更小、纤维帽更薄、破裂斑块、易损斑块和血栓更多见（P〈0．05或0．01）；而且hs—CRP和proMMP-1水平更高（P〈005或0．01）。hs—CRP与EEMCSA、脂核负荷、斑块负荷、纤维帽厚度、斑块类型均相关（P〈0．05或0．01），ProMMP-1则仅与斑块类型相关（P〈O01）；吸烟、HDL—C、hs—CRP、肌钙蛋白I均与MACE独立相关（P〈0．05或0．01）。结论hs—CRP与斑块不稳定性相关，是冠心病患者发生MACE的独立危险因素，结合相关血管内超声指标可对冠心病患者预后进行评估。Objective To investigate the prognosis value of inflammation factors and coronary lesion characteristics in patients with coronary artery disease （CHD）. Methods Eighty nine patients with acute coronary syndrome （ACS）and 72 patients with stable angina （SA） were enrolled in the study. Coronary lesion characteristics were examined by intravaseular ultrasound （IVUS） before percutaneous coronary intervention. Plasma concentrations of high sensitive C-reaction protein （hs-CRP） and Pro-matrix metalloproteinase-1 （ProMMP-1） were measured by enzyme linked immunosorbent assay. Patients were followed 1 year for subsequent major adverse cardiac events （MACE）. Events were defined as death, myocardial infarction, and any revascularization. Results Patients with ACS had increased external elastic membrane cross-sectional area （EEM CSA）, plaque burden, lipid pool burden, smaller minimal lumen cross-sectional area, thinner fibrous-cap compared with those with SA; ruptured and vulnerable plaques, positive remolding and thrombus were more frequently observed in ACS patients （P 〈 0.05 or 0.01 ）. The level of plasma hs-CRP and proMMP-1 were higher in patients with ACS （P 〈 0.05 or 0.01 ）. Strong associations were found between hs-CRP and EEM CSA, plaque burden, lipid pool burden and the type of the plaque （P〈 0.05 or 0.01 ）,while only the type of the plaque had the association with proMMP-1 （P〈 0.01 ）. Smoking, high density lipoprotein, hs-CRP and troponin I were independently associated with MACE（P〈 0.05 or 0.01 ）. Conclusion There is a strong association between hs-CRP and the vulnerability of plaque, hs-CRP is an independent risk factor for MACE and can be used for evaluation of the prognosis of patients with CHD combined with correlated coronary arterial culprit lesions of IVUS.

关 键 词：冠状动脉疾病 超敏C反应蛋白 血管内超声 主要心脏不良事件 

分 类 号：R541.4[医药卫生—心血管疾病]