摘要
目的探讨冠状动脉(冠脉)粥样斑块稳定性和炎症反应在急性冠状动脉综合征(ACS)中的作用。方法对28例ACS和13例稳定性心绞痛(SA)患者“罪犯”冠脉进行血管内超声(IVUS)检查,同时测定外周血清高敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)、组织型基质金属蛋白酶抑制剂-1(TIMP-1)、可溶性CD40L(sCD40L)含量。结果ACS患者冠脉病变处以软斑块为主71.4%(20/28),SA患者冠脉病变处以硬斑块为主76.9%(10/13),差异有统计学意义(P=0.004)。与SA组比较,ACS组病变处斑块面积大(P=0.004)、斑块负荷重(P=0.048)、以正性重构为主(P=0.013)。ACS组血清hs-CRP、MMP-9、sCD40L含量均高于SA组,TIMP-1含量在ACS组和SA组之间差异无统计学意义(P=0.234),ACS组hs-CRP与MMP-9(r=0.671,P=0.000)、sCD40L(r=0.494,P=0.008)呈正相关。结论冠脉“罪犯”病变处结构性易损斑块是ACS发作基础,CD40L和MMP-9参与的炎症反应导致斑块功能性不稳定和不同临床表现。
Objective To elucidate the effect of inflammation and coronary atherosclerotic plaque destabilization in the pathogenesis of acute coronary syndromes （ ACS ）. Methods Twenty-eight patients with ACS and 13 patients with stable angina pectoris （SA） were examined by intravascular ultrasound （IVUS）. Coronary plaque morphology and areas in culprit lesions were analyzed. The serum levels of hs- CRP, MMP-9, TIMP-1, sCIMOL were also measured. Results Soft plaques were dominant in culprit lesions of ACS patients （71.4% , 20/28） , and hard plaques were dominant in culprit lesions of SA patients [76. 9% （10/13） , P =0. 004]. At the culprit site, plaque area, plaque burden and remodeling index were all significantly larger in culprit lesions of ACS patients than those of SA patients （ all P 〈 0.05 ）. Positive remodeling was more frequent in ACS patients than in SA patients, whereas negative remodeling was more frequent in SA patients （P 〈 0.05 ）. The serum levels of hs-CRP, MMP-9, sCD40L were higher in ACS group compared with SA group （P 〈 0.05, respectively）. Moreover, hs-CRP level was positively correlated with MMP-9 （r =0. 671, P =0. 000） and sCD40L （r =0. 494, P =0. 008）, respectively, in ACS patients. There was no difference in TIMP-1 between two groups （P = 0. 234）. Conclusions These results suggest that structurally vulnerable plaques are essential element in the pathogenesis of ACS and inflammation might play an important role in plaque vulnerability.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2006年第6期512-514,共3页
Chinese Journal of Cardiology
基金
国家自然科学基金资助项目(30470702
30570747)
卫生部临床学科重点项目(20012943
20044681)
关键词
冠状动脉疾病
斑块
炎症
超声检查
血管内
Coronary disease
Plaque
Inflammation
Uhrasonography, intravascular
