冠心病与颈动脉斑块及丙二醛化低密度脂蛋白的相关性研究

Relation of angiographic type Ⅱ lesion to ultrasonographic carotid atherosclerotic plaque and MDA-LDL in patients with coronary heart disease

目的研究冠心病患者冠心病与颈动脉内-中膜厚度(CCA-IMT)、斑块指数及丙二醛化低密度脂蛋白(MDA-LDL)的相关性。方法收集冠状动脉造影的冠心病患者82例,根据斑块形态,冠心病患者分为3组,即Ⅰ型病变(表面光滑)组(n=31),Ⅱ型病变(表面不规则)组(n=a2)及Ⅲ型病变(长段不规则)组(n=19),冠状动脉造影正常的25例为对照组纳入研究。采用高频超声探测各组双侧颈动脉 IMT 和软斑指数,硬斑指数及总斑块指数,以及测定血浆 MDA-LDL 含量。结果 (1)冠心病各组(包括Ⅰ型、Ⅱ型、Ⅲ型病变组)CCA-IMT、软斑 PI、硬斑PI、总斑 PI 与对照组相比明显增高(均P<0.01);冠心病Ⅱ型病变组软斑 PI、总斑 PI 与Ⅰ型、Ⅲ型病变组相比明显增高(P<0.01);Ⅱ型病变组血浆 MDA-LDL 含量与Ⅰ型、Ⅲ型病变组及照组相比明显增高(P<0.01)。(2)Ⅱ型病变组 MDA-LDL 含量与软斑 PI、总斑 PI 呈正相关(r=0.63,P<0.01;r=0.51,P<0.05)。结论通过颈动脉超声检测,颈动脉斑块(特别是软斑)的检出,结合血浆 MDA-LDL 含量,可以初步预测冠心病患者冠状动脉斑块的不稳定。

Objective To evaluate the relation of angiographic type Ⅱ lesion （representing unstable or ruptured plaque, with or without thrombosis） to uhrasonographic intima-media thickness （IMT）, atherosclerotic plaque indices and plasma malondialdehyde-modified low density lipoprotein （MDA-LDL）level in patients with coronary heart disease（CHD）. Methods One hundred and seven patients who underwent coronary angiography were divided into two groups：CHD group （82 cases） and normal control group （25 cases）. The angiographic morphology of plaques was analyzed. According to the morphologic types of plaque, patients with CHD were divided into type Ⅰ （smooth borders）group （n=31）, type Ⅱ （irregular lesions） group （n=32） and type Ⅲ （long lesions） group （n=19）. Carotid IMT and plaque indices were assessed by high frequency uhrasonography and plasma MDA-LDL levels were measured. Results （1） Compared with normal control group, common carotid artery（CCA）-IMT, soft and hard plaque indices, total plaque index in CHD patients （including type Ⅰ , Ⅱ , Ⅲ groups） were significantly increased （P〈0.01, respectively）. Soft plaque indices and total plaque index in type Ⅱ＊ group were significantly higher than in type Ⅰ group and in type Ⅲ group. The plasma MDA-LDL level was significantly elevated in type Ⅱ group than in normal control group, type Ⅰ group, and type Ⅲ group （P〈0. 01, respectively）. （3） In type Ⅱ group, plasma MDA-LDL level was significantly positive correlated with soft plaque indices and total plaque index （r=0.63, P〈0.01;r=0.51, P〈0.05 respectively）. Conclusions Angiographic morphology of the coronary artery lesion in CHD patients can be predicted by combination of uhrasonographic carotid soft plaque indices and plasma MDA-LDL level.