急性冠状动脉综合征患者血管因子与冠状动脉斑块特征的相关性研究

Relationship between serum vasoactive factors and plaque morphology in patients with acute coronary syndrome

目的探讨急性冠状动脉综合征(ACS)患者血管因子与冠状动脉斑块特征的相关性。方法选择56例 ACS 患者,年龄(60±11)岁,男37例,女19例,发病时取血,应用液相蛋白芯片结合流式细胞分析方法测定7种血管因子:可溶的 P 选择素(sPE)、组织血纤维蛋白溶酶原激活物(tPA)、单核细胞趋化蛋白1(MCP-1)、白细胞介素(IL)-8、IL-6、可溶的血管细胞间黏附分子1(sVCAM-1)和可溶的黏附分子40配体(sCD40L),以及相应的炎症因子;常规冠状动脉造影,并用血管内超声(IVUS)检测56个靶病变处动脉粥样斑块形态学及性质特征。分析急性心肌梗死(AMI)与不稳定性心绞痛(UA)患者、易损斑块与非易损斑块组发生斑块破裂时的血管因子改变以及斑块形态学指标与血管因子的相关性。结果存在密切相关的血管因子有 sVCAM-1和 sPE、sVCAM-1和sCD40L、sCD40L 和 sPE、IL-6和 IL-8、IL-8和 MCP1、以及 MCP1和 sVCAM-1;易损斑块组的高敏 C 反应蛋白(hs-CRP)为(18.9±4.9)mg/L,IL-5为[19.5 ng/L(9.2～44.6 ng/L)],明显高于非易损斑块组[hs-CRP:(5.8±3.6)mg/L,IL-6:5.3 ng/L(2.3～13.4 ng/L),均 P<0.05];与非斑块破裂组比较,斑块破裂组的 sCD40L[(474±126)ng/L 比(238±35)ng/L],sPE[(107.2±39.9)ng/L 比(49.1±5.6)μg/L]和 MCP-1[(132±18)ng/L 比(127±13)ng/L]明显升高(均 P<0.05);tPA 与斑块形态之间存在一定的相关性(均 P<0.05)。sCD40L、MCP-1,sPE 和 TC 水平升高是发生斑块破裂的独立危险因素(均 P<0.05)。结论炎症反应作为中间过程,IL-6和 CRP 标志易损斑块的生物特点,对AMI 可能有一定的诊断意义,而 sCD40L、MCP-1和 sPE 可能是另一个潜在的反映 ACS 严重发作的标志。

Objective To investigate the relationship between vasoactive factors and plaque morphology in patients with acute coronary syndrome（ACS）. Methods Intravascular ultrasound （IVUS） were performed and 7 serum vasoactive factors（sPE,tPA, MCP-1, IL-8,IL-6,sVCAM-1 and sCD40L） were measured through cytometric bead array, serum hs-CRP, HCY, glucose and lipid level were also determined in consecutively enrolled 56 patients with ACS. The changes of bio-factors were compared between vulnerable plaque and non-vulnerable plaque groups, AMI and UA patients, and patients with or without plaque rupture. Results Biomarkers were similar between patients with unstable angina pectoris and AMI. hs-CRP [（18.9±4.9）mg/l vs. （5.8 ±3.6） mg/L）]and IL-6 [19.5 pg/ml （9.2-44.6 pg/ml） vs. 5.3 pg/ml （2. 3-13. 4 pg/ml） ] were significantly higher in the group of vulnerable plaque（P 〈0. 05）compared to non-vulnerable plaques group, sCD40L[ （474 ± 126）pg/ml vs. （238 ±35） pg/ml] ,sPE[ （ 107. 2 ±39.9） μg/ml vs. （49. 1±5.6） μg/ml] and MCP-1 [（132 ± 18） pg/ml vs. （127 ± 13） pg/ml] were significantly increased in the plaque rupture group than that in non-plaque rupture group （ all P 〈 0. 05 ）. Increasing of sCD40L,MCP-1 ,sPE and TC were independent risk factors for plaque rupture. Conclusions IL-6 and hs- CRP are biomarkers for vulnerable plaques and diagnosis of acute myocardial infarction, sCD40L, MCP-1 and sPE may serve as the potential markers predicting plaque rupture in patients with ACS.