脂蛋白(a)水平与VH-IVUS检测冠脉粥样硬化斑块成分的关联性分析  

Analysis on correlation between lipoprotein(a) and VH-IVUS examination of atherosclerotic plaque in patients with CHD

作　　者：张宜春[1] 徐岩[2] 辜和平[1] 

机构地区：[1]安徽医科大学附属安庆医院心内科,安徽安庆246003 [2]安徽医科大学附属第一医院心内科,安徽合肥230022

出　　处：《吉林大学学报（医学版）》2016年第1期115-119,I0003,共6页Journal of Jilin University：Medicine Edition

基　　金：安徽省科技厅科技攻关项目资助课题(09010302083);安徽省卫生厅医学科研重点项目资助课题(2010B005);安徽医科大学科研基金资助课题(2015xkj158)

摘　　要：目的:利用虚拟组织学血管内超声(VH-IVUS)评价冠心病(CHD)患者冠状动脉病变斑块成分与脂蛋白(a)[Lp(a)]的关系,探讨Lp(a)在斑块易损机制中的作用。方法:选择54例胸痛患者,依据患者症状及冠状动脉造影(CAG)结果分为非ST段抬高型急性冠脉综合征组(NSTEACS)18例、稳定型心绞痛(SAP)组21例及对照组(CAG显示管腔未见异常者)15例。测定患者血清生化指标,采用VH-IVUS检查NSTEACS和SAP组患者病变斑块,分析斑块成分与Lp(a)关联性。结果:与对照组比较,NSTEACS组和SAP组患者Lp(a)、低密度脂蛋白(LDL)和超敏C反应蛋白(hs-CRP)水平明显升高(P<0.05),且NSTEACS组患者血清Lp(a)、hs-CRP和LDL水平高于SAP组(P<0.05)。与SAP组比较,NSTEACS组患者病变斑块含坏死组织(NC)、纤维脂质(FF)成分百分比和易损斑块(TCFA)发生率明显增高(P<0.05)。Lp(a)与斑块中含NC、FF成分百分比及TCFA发生率和血清hs-CRP水平呈正相关关系(r分别为0.411、0.312、0.318和0.309),差异有统计学意义(P<0.05)。结论:NSTEACS患者斑块不稳定随Lp(a)升高而增加。Lp(a)是反映易损斑块的敏感性指标。Objective To analyze the characteristics of atherosclerotic plaques in the patients with coronary heart disease （CHD） by virtual histology intravascular ultrasound （VH-IVUS）, and to discuss their correlations with lipoprotein （a） [-Lp（a）. Methods= 54 patients with chest pain were divided into non ST elevation acute coronary syndromes （NSTEACS） group （n=18）, stable angina pectoris （SAP） group （n=21） and control group （n= 15） according to the symptoms and coronary angiography results of the patients. The serum biochemical indexes were measured in all patients. In 39 CHD patients, culprit lesions were detected with VH-IVUS to investigate the characteristics of atherosclerotic plaques and their relevance with Lp（a）. Results： The levels of Lp（a）, low density lipoprotein （LDL） and hypersensitive C reactive protein （hs-CRP） of the patients in NSTEACS and SAP groups were significantly higher than those in control group （P〈 0. 05） ; the levels of serum Lp（a）, hs-CRP and LDL in NSTEACS group were higher than those in SAP group （P〈0.05）. The incidence of necrotic tissue （NC）, fiber lipid （FF）, and vulnerable plaque （TCFA） in lesion patches of the patients in SAP group were significantly decreased （P〈0.05） compared with NSTEACS group. The plasma Lp（a） was positively associated with NC, FF, TCFAserum and hs-CRP （r= 0.411, r = 0.312, r = 0.318, r = 0.309, P〈0.05）. Conclusion.. The vulnerability of plaques in the NSTEACS patients in creases with the increase of Lp（a） level： Plasma Lp（a） is a sensitive index for evaluating the plaque vulnerability.

关 键 词：脂蛋白(a) 虚拟组织学 血管内超声 易损斑块 

分 类 号：R541.4[医药卫生—心血管疾病]