颈动脉硬化斑块与血浆高敏C-反应蛋白、基质金属蛋白酶-2/9、CD40配体水平的关系

Associations between the carotid artery plaque and the level of high sensitive C-reactive protein,matrix metalloproteinase-2/9,CD40 ligand

目的通过超声检查颈动脉硬化斑块,结合检测患者血浆高敏C-反应蛋白(hs-CRP)、基质金属蛋白酶(MMP,包括MMP-2、MMP-9)、CD40配体(CD40L)水平综合评价斑块的易损性。方法对68例首次发病的脑梗死患者(A组)、62例无症状颈动脉硬化患者(B组)和56例健康对照者(C组)进行研究,超声检查颈动脉内膜-中层厚度(IMT)、斑块类型,采用酶联免疫吸附法检测血浆hs-CRP、MMP-2、MMP-9、CD40L。A组患者进行神经功能缺损程度评分。结果 A组IMT高于B组(P=0.024),A组以易损斑块(60.3%)为主,B组以稳定斑块(77.4%)为主;A组患者血浆hs-CRP、MMP-2、MMP-9、CD40L水平均高于B组和C组(均P<0.05);A组易损斑块者血浆MMP-2、MMP-9、CD40L水平均高于稳定斑块和无斑块者(均P<0.05);易损斑块者hs-CRP与MMP-2、MMP-9均呈正相关(r=0.516,P=0.001;r=0.653,P=0.001);MMP-2与MMP-9、CD40L均呈正相关(r=0.637,P=0.001;r=0.614,P=0.010);MMP-9与CD40L呈正相关(r=0.749,P=0.012);易损斑块者神经功能缺损程度评分(26.19±11.25)高于稳定斑块(23.58±10.46)及无斑块者(23.14±10.18);血浆hs-CRP、MMP-2、MMP-9、CD40L与神经功能缺损程度评分均呈正相关(r=0.652,P=0.001;r=0.761,P=0.001;r=0.729,P=0.001;r=0.648,P=0.010)。结论超声检查颈动脉硬化斑块类型结合检测血浆相关炎症介质水平有助于评价斑块的易损性。

Objective To evaluate the vulnerability of carotid artery plaque by ultrasonic inspection of carotid artery plaque,combined with the study on the level of high sensitive C-reactive protein(hs-CRP),matrix metalloproteinase(MMP,including MMP-2,MMP-9),CD40 ligand in plasma of patients.Methods Sixty-eight patients with the first ever cerebral infarction(group A),62 with asymptomatic carotid atherosclerosis(group B)and 55 normal controls(group C)were investigated.The intima-medial thickness(IMT),plaque type were detected or calculated respectively by ultrasonic inspection.Then the plasma levels of hs-CRP,MMP-2,MMP-9 and CD40L were measured with ELISA.The patients of A group were evaluated with neurologic impairment scale.Results Compared with B group,the IMT in A group were higher,the main in A group were the vulnerable plague(60.3%),and stable plaque in B group(77.4%);the plasma levels of hs-CRP,MMP-2,MMP-9 and CD40L in A group were higher than B group and C group(P<0.05,respectively).The plasma levels of MMP-2,MMP-9 and CD40L in vulnerable plaque of carotid in A group were higher than stable plaque and no plaque patients(P<0.05,respectively).In the vulnerable plague patients,correlation analysis manifested positive correlation between levels of hs-CRP and MMP-2,MMP-9(r=0.516,P=0.001;r=0.653,P=0.001,respectively),MMP-2和MMP-9,CD40L(r=0.637,P=0.001;r=0.614,P=0.001,respectively);MMP-9 and CD40L(r=0.749,P=0.012).Neurologic impairment scale in the vulnerable plague patients(26.19±11.25)were higher than stable plaque(23.58±10.46)and no plaque(23.14±10.18)patients.hs-CRP,MMP-2,MMP-9,CD40L and neurologic impairment scale is positive correlation(r=0.652,P=0.001;r=0.761,P=0.001;r=0.729,P=0.001;r=0.648,P=0.010,respectively).Conclusions Ultrasonic inspection of the type of carotid artery plaque,combined with the study on plasma levels of inflammatory mediators were hepful in judging the vulnerability of carotid artery plaques.