冠心病患者血清hs-CRP、YKL-40水平与纤维脂质斑块纤维帽厚度的关系  

Relationship between serum hs-CRP and YKL-40 levels and the thickness of fibrous cap of fibrolipid plaques in patients with coronary heart disease

作　　者：杨宏伟 尹栩芳 张凯[1] 陆亚萍 樊一笋 赵燕萍 YANG Hongwei;YIN Xufang;ZHANG Kai;LU Yaping;FAN Yisun;ZHAO Yanping(Suzhou Jiulong Hospital Affiliated to Medical College of Shanghai Jiaotong University,Suzhou 215021,China)

机构地区：[1]上海交通大学医学院附属苏州九龙医院

出　　处：《山东医药》2019年第31期27-31,共5页Shandong Medical Journal

基　　金：江苏省医学科研基金立项项目(H2016129)

摘　　要：目的探讨冠心病患者血清高敏C反应蛋白(hs-CRP)、甲壳质酶蛋白40(YKL-40)与纤维脂质斑块纤维帽厚度的关系。方法选择冠心病患者159例(观察组),临床类型:急性心肌梗死(AMI)43例、不稳定型心绞痛(UAP)59例、稳定型心绞痛(SAP)57例,纽约心脏病学会(NYHA)心功能分级:Ⅱ级68例、Ⅲ级53例、Ⅳ级38例,冠状动脉狭窄支数:无狭窄59例、单支狭窄42例、双支狭窄33例、多支狭窄25例,同期选择体检健康者40例作为对照组。采集两组外周静脉血各5 mL,离心分离血清,采用ELISA法检测血清hs-CRP、YKL-40。采用光学干涉断层成像(OCT)检测纤维脂质斑块纤维帽厚度。采用受试者工作特征(ROC)曲线评估血清hs-CRP、YKL-40单独和联合检测预测纤维脂质斑块纤维帽厚度的价值。结果观察组血清hs-CRP、YKL-40水平均高于对照组(P均<0.05)。AMI、UAP、SAP患者血清hs-CRP、YKL-40水平逐渐降低,纤维脂质斑块纤维帽厚度逐渐升高(P均<0.05)。NYHA心功能分级Ⅱ、Ⅲ、Ⅳ级者血清hs-CRP和YKL-40水平逐渐降低,纤维脂质斑块纤维帽厚度逐渐升高(P均<0.05)。冠状动脉无狭窄、单支狭窄、双支狭窄、多支狭窄者血清hs-CRP和YKL-40水平逐渐降低,纤维脂质斑块纤维帽厚度逐渐升高(P均<0.05)。Pearson积矩相关分析显示,冠心病患者血清hs-CRP、YKL-40水平均与纤维脂质斑块纤维帽厚度呈负相关关系(P均<0.05)。ROC曲线分析显示,血清hs-CRP、YKL-40单独检测预测纤维脂质斑块纤维帽厚度<65μm的曲线下面积(AUC)分别为0.796、0.864,血清hs-CRP、YKL-40联合检测预测纤维脂质斑块纤维帽厚度<65μm的AUC为0.939;血清hs-CRP、YKL-40联合检测预测纤维脂质斑块纤维帽厚度<65μm的价值高于二者单独检测(Z分别为3.682、4.353,P均<0.05)。结论冠心病患者血清hs-CRP、YKL-40水平明显升高,其水平升高与病情程度密切相关;血清hs-CRP、YKL-40联合检测可用于预测纤维脂质斑块纤维�Objective To investigate the relationships between serum high-sensitivity C-reactive protein(hs-CRP)and chitinase protein 40(YKL-40)levels and the thickness of fibrous cap of fibrolipid plaques in patients with coronary heart disease.Methods Totally 159 patients with coronary heart disease(observation group),including 43 cases of acute myocardial infarction(AMI),59 cases of unstable angina pectoris(UAP),57 cases of stable angina pectoris(SAP),68 cases of gradeⅡof New York College of Cardiology(NYHA)Heart Function,53 cases of gradeⅢ,38 cases of gradeⅣ,and 59 cases without stenosis,42 cases with single stenosis,33 cases with double stenosis,and 25 cases with multiple stenosis,were selected.Meanwhile,40 healthy persons were selected as the control group.Peripheral venous blood(5 mL)of the two groups was collected.The serum levels of hs-CRP and YKL-40 were measured by ELISA,and the thickness of fibrous cap of fibrolipid plaque was measured by optical coherence tomography(OCT).We used the receiver operating characteristic(ROC)curve to evaluate the predictive values of detecting serum hs-CRP,YKL-40 alone and in combination to the thickness of fibrin plaque fiber caps.Results The levels of hs-CRP and YKL-40 in the observation group were higher than those in the control group(both P<0.05).The levels of hs-CRP and YKL-40 in serum of patients with AMI,UAP,and SAP decreased gradually,while the thickness of fibrous cap of fibrolipid plaque increased gradually(both P<0.05).The levels of hs-CRP and YKL-40 in serum of patients with NYHA cardiac function gradesⅡ,ⅢandⅣdecreased gradually,and the thickness of fibrous cap of fibrolipid plaques increased gradually(both P<0.05).The levels of hs-CRP and YKL-40 in serum of patients without coronary artery stenosis,with single stenosis,double stenosis and multiple stenosis gradually decreased,and the thickness of fibrous cap of fibrolipid plaque gradually increased(both P<0.05).Pearson product moment correlation analysis showed that the serum levels of hs-CRP and YKL-40 were

关 键 词：冠心病 高敏C反应蛋白 甲壳质酶蛋白40 纤维脂质斑块 纤维帽厚度 

分 类 号：R543.3[医药卫生—心血管疾病]