血C反应蛋白与冠状动脉不稳定斑块的关系

Relation of coronary vulnerable plaque instability to serum levels of C-reactive protein in ACS

目的：通过检测85例冠心病患者血C反应蛋白（CRP）水平，并与冠状动脉斑块形态特征对比分析，探讨血CRP与冠状动脉不稳定斑块的相互关系。方法：入选诊断明确的冠心病患者85例，分为研究组57例急性冠状动脉综合征（ACS），非ST段抬高心肌梗死组（NSTEMI组）21例与不稳定型心绞痛组（UAP组）36例；对照组为28例稳定型心绞痛（SAP）患者。所有患者用酶联免疫法测定血浆CRP和心肌肌钙蛋白I（Tn I）水平。通过冠状动脉造影检查，将冠状动脉病变斑块血管形态按照Ambrose分型分为I-Ⅲ型，与血CRP水平进行相关分析。结果：1．NSTEMI组和UAP组血CRP和Tn I水平均显著高于SAP组[（20．2±8．3、8．64±4．2、15．6±5．3、2．56±1．38）]VS[（9．61±4．1、0．20±0．03，P〈0．05）]；2．血CRP水平与冠状动脉Ambrose斑块形态分型有关，尤其是Ⅱ型不稳定斑块者明显增高，但与冠状动脉病变的狭窄程度无关。3．NSTEMI组（95％）和中高危UAP组（92％）大部分患者的斑块病变为Ambrose斑块形态分型的Ⅱ-Ⅲ型。结论：ACS组患者血CRP水平显著升高，与冠状动脉粥样硬化斑块的不稳定性有关，可作为预测不稳定斑块的指标。

Objective：To explore the relationship between coronary vulnerable plaque instability and serum C-reactive protein（CRP） levels in 85 patients with coronary heart disease. Method： 85 patients（ aged 63±16, M = 52） were divided into two groups, The control group was 28 patients with stable angina pectoris （SAP）, The study group was 57 patients with acute coronary syndrome （ACS）, which were further divided into 21 patients with non ST elevated myocardial infarction （NSTEMI） and 36 patients with unstable angina pectoris （UAP）. CRP were measured as well as coronary angiography made for all 85 patients. Plaques of coronary culprit arteries were classified as Ⅰ-Ⅲ three types according to Ambrose classification. Result： 1. CRP levels of NSTEMI and UAP groups were significant higher than in SAP group. 2. The levels of CRP correlated with Ambrose classification, especially positively with Ambrose Ⅱ type, but no relation with coronary narosis. 3. The Plaques of coronary culprit arteries in high risk of NSTEMI and UAP patients were mostly Ambrose Ⅱ or Ⅲ type. Conclusion： The prevalence of higher levels of CRP in patients with ACS,when compared with those of SAP, was associated with the instability of coronary vulnerable plaques （ie, Ambrose Ⅱ type）. So, CRP are not only markers of vulnerable plaques, but also indicators of ACS prognosis.