血浆脂多糖与冠状动脉血管内超声斑块结构特点相关性的临床研究  

Clinical study on the correlation between plasma lipopolysaccharide and the structural characteristics of coronary intravascular ultrasound plaques

作　　者：胡梦弦 何贵新[1,2] 袁冬梅 秦伟彬 林琳[2] 冯雨菲 郑国坤 甲子永 HU Meng-xian;HE Gui-xin;YUAN Dong-mei;QIN Wei-bin;LIN Lin;FENG Yu-fei;ZHENG Guo-kun;JIA Zi-yong(Guangxi University of Traditional Chinese Medicine,Nanning 530299,China;The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530022,China)

机构地区：[1]广西中医药大学,广西南宁530299 [2]广西中医药大学第一附属医院,广西南宁530022

出　　处：《海南医学院学报》2022年第12期904-909,共6页Journal of Hainan Medical University

基　　金：国家自然科学基金地区基金项目(81960861、81460712);广西科学重点研发计划项目课题(桂科AB19110006);广西研究生教育创新计划资助项目(YCXJ2021052)。

摘　　要：目的:研究血浆脂多糖(lipopolysaccharide,LPS)与冠状动脉粥样硬化性心脏病及斑块稳定性的相关性。方法:选取广西中医药大学第一附属医院行冠状动脉造影术(coronary arteriography,CAG)和血管内超声(intravascular ultrasound,IVUS)检查的不稳定性心绞痛患者136例,根据IVUS结果将其分为稳定性斑块组(stable plaques,SP)(72例)和不稳定性斑块组(unstable plaques,UP)(64例),抽取所有患者静脉血进行血脂和LPS指标检测,分析两组患者血管内超声斑块结构特点,研究UP的影响因素和LPS与斑块结构特征的相关性及对UP的诊断效能。结果:UP组总胆固醇、低密度脂蛋白、LPS表达水平均高于SP组(P<0.05),高密度脂蛋白表达水平低于SP组(P=0.035);且斑块血管内超声结构中UP组的脂质池面积、脂质池占斑块面积比、斑块偏心指数、最大斑块厚度值均高于SP组(P<0.05),斑块最小厚度小于SP组,差异有统计学意义(P<0.05);经Spearman相关性检验LPS与总胆固醇、低密度脂蛋白、脂质池面积、脂质池占斑块面积比、斑块偏心指数、斑块最大厚度呈正相关(P<0.05),与高密度脂蛋白成负相关(P=0.021);二元逻辑回归分析显示,LPS是导致冠状动脉斑块不稳定的危险因素(OR:1.831,95%CI:0.662,0.999,P=0.002),高密度脂蛋白是冠状动脉斑块稳定的保护因素,差异具有统计学意义(OR:0.028,95%CI:0.011,0.356,P=0.049);LPS诊断冠状动脉粥样硬化斑块稳定性ROC曲线下面积(AUC)为0.889(95%CI:0.805,0.974),最佳诊断点为57.485 mg/L,其灵敏度为80.60%,特异度为73.70%。结论:血浆LPS升高是不稳定性斑块的危险因素,对冠状动脉斑块具有一定的诊断价值,可作为斑块易损性的定量诊断指标。Objective:To study the correlation between plasma lipopolysaccharide(LPS)and plaque stability in coronary atherosclerotic heart disease.Methods:A total of 136 patients with unstable angina pectoris who underwent coronary angiography(CAG)and intravascular ultrasound(IVUS)in the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine were selected for this study.According to the results of IVUS,these patients were divided into stable plaques group(stable plaques,SP)(n=72)and unstable plaques group(UP)(n=64),venous blood were collected for blood lipid and lipopolysaccharide index detection;the structural characteristics of the intravascular ultrasound plaques in the two groups were analyzed.The relationship between LPS and the structural characteristics of the plaques as well as the affecting factor of SP were explored in order to evaluate the diagnostic value of LPS in UP.Results:The expression levels of cholesterol,low-density lipoprotein,and LPS in the UP group were higher than those in the SP group(P<0.05),while the high-density lipoprotein expression levels were lower than those in the SP group(P=0.035);According to the IVUS results,the lipid pool area,the ratio of lipid pool to plaque area,the plaque eccentricity index,and the maximum plaque thickness of the UP group were significant higher than those of the SP group(P<0.05),while the minimum plaque thickness was smaller than that of the SP group and the difference was statistically significant(P<0.05).LPS was positively correlated with cholesterol,low-density lipoprotein,lipid pool area,ratio of lipid pool to plaque area,plaque eccentricity index,and maximum plaque thickness by Pearson correlation test(P<0.05),while negatively correlated with high-density lipoprotein(P=0.021);LPS is a risk factor for coronary plaque stability(OR:1.831,95%CI:0.662,0.999,P=0.002),but HDL is a protective factor for coronary plaque stability by binary logistic regression test(OR:0.028,95%CI:0.011,0.356,P=0.049).ROC area under the curve(AUC)for the value of

关 键 词：血浆脂多糖 斑块稳定性 血管内超声 不稳定性心绞痛 

分 类 号：R541.4[医药卫生—心血管疾病]