64层螺旋CT联合炎症因子检测急性冠状动脉综合征患者易损斑块的相关研究

Combined examination of 64-slice spiral computed tomography and inflammatory cytokines in the detection of vulnerable plaque of acute coronary syndrome

目的评价64层螺旋CT联合炎症因子高敏C反应蛋白(hs-CRP)及基质金属蛋白酶9(MMP-9)检测急性冠状动脉综合征(ACS)患者易损斑块的临床价值。方法入选72例冠心病患者,其中ACS组43例,稳定型心绞痛(SAP)组29例,进行64层螺旋CT冠状动脉成像,根据CT值将ACS组、SAP组犯罪血管处斑块分为软斑块、纤维斑块、钙化斑块。同时检测患者血清hs-CRP及血浆MMP-9浓度,并进行选择性冠状动脉造影检查,明确冠状动脉病变部位及性质。对照组25例。结果(1)ACS组软斑块发生率较SAP组明显高,差异有统计学意义(24/43比4/29,P=0.001);(2)与对照组比较,SAP、ACS组hs-CRP(4.12±2.82mg/L比6.11±2.60mg/L比11.26±3.03mg/L)、MMP-9(54.87±47.73ng/mL比91.69±55.72ng/mL比187.86±64.73ng/mL)浓度明显升高,差异有统计学意义(P均<0.05);且ACS组较SAP组升高更明显,差异有统计学意义(P<0.05);(3)冠心病的软斑块亚组与纤维斑块、钙化斑块亚组比较hs-CRP(12.69±2.41mg/L比7.47±2.52mg/L比6.39±2.87mg/L)、MMP-9(211.67±57.87ng/mL比121.48±55.86ng/mL比95.99±62.29ng/mL)浓度明显升高,差异有统计学意义(P均<0.05);(4)冠心病患者冠状动脉斑块CT值与hs-CRP、MMP-9浓度呈负相关。结论联合检测炎症因子hs-CRP及MMP-9,能够提高64层螺旋CT检测ACS患者冠状动脉斑块性质的准确性,并提示斑块稳定性,提高对ACS的诊断率。

Objective To evaluate tile clinical value of 64-slice spiral computed tomography combined with hs-CRP and MMP-9 to detect the vulnerable plaque of acute coronary syndrome. Methods Seventy-two patients with coronary heart disease were included and among them, 43 patients were diagnosed as ACS and the other 29 patients diagnosed as stable angina group （SAP）. All patients underwent 64-slice spiral computed tomography coronals＇ artery imaging and examination of plasma hs-CRP and MMP-9 concentration. All patients underwent selective coronary angiography. Another 25 cases who underwent coronary angiography were included in the control group. Results The incidence of soft plaque was higher in the ACS group than in the SAP group （24 eases vs 4 cases, P = 0. 001 ）. Compared with the control group, levels of hs-CRP and MMP-9 in the ACS group and the SAP group were both significantly higher （ all P〈0. 05） and furthermore, hs-CRP and MMP-9 in the ACS group was higher than in the SAP group （P〈 0. 05）. Compared with patients with fibrous plaque and calcified plaque, plasma hs-CRP and MMP-9 levels in patients with soft plaque were significantly higher （P 〈 0. 05 ）. The CT value was negatively correlated to hs-CRP and MMP-9 levels. Conclusion Combined detection of inflammatory cytokines hs-CRP and MMP- 9 can improve the accuraey of 64-slice spiral computed tomography in the diagnosis coronary artery plaque.