脂蛋白相关磷脂酶A_2与血管内超声虚拟组织学斑块特征的关系及临床意义

The relation of virtual histological features of coronary atherosclerotic plaques and lipoprotein-associated phospholipase A_2 and the clinical implications

目的:通过观察不同类型冠心病患者血浆脂蛋白相关磷脂酶A2(Lp-PLA2)、超敏-C反应蛋白(hs-CRP)及其与血管内超声虚拟组织学(IVUS-VH)冠状动脉斑块特征的关系,以探讨Lp-PLA2检测对评价易损斑块炎症程度的意义。方法:选择我院急性冠状动脉综合征患者51例(ACS组)、稳定型心绞痛患者39例(SAP组)及可排除冠心病者30例(CTL组)。应用ELSIA法测定Lp-PLA2及hs-CRP、冠状动脉造影(CAG)及IVUS-VH评价斑块的形态特征。结果:ACS组血浆Lp-PLA2(P<0·01)及hs-CRP(P<0·05)分别显著高于SAP组,SAP组血浆Lp-PLA2(P<0·05)及hs-CRP(P<0·05)分别显著高于CTL组;ACS组狭窄病变处主要为脂质坏死性斑块,而SAP组主要为纤维性斑块(P<0·01),ACS组和SAP组脂质坏死组织面积百分比分别为(33·26±9·90)%和(8·26±6·77)%(P<0·01),薄纤维帽脂瘤斑块分别为43%和10%(P<0·01);血浆Lp-PLA2和hs-CRP水平分别与脂质坏死组织面积百分比呈正相关(r=0·511,P=0·019;r=0·412,P=0·026),与斑块重塑指数呈显著正相关(r=0·567,P=0·012;r=0·402,P=0·043)。结论:血浆Lp-PLA2水平与IVUS确定的斑块易损指标相关,Lp-PLA2可作为易损斑块的炎症标记,其价值与hs-CRP相仿或更优。

Objective：To assess the relationship of the features of coronary atherosclerotic plaques detected by intravascular ultrasound （IVUS） and virtual histological imaging （IVUS-VH） with high sensitivity C-reactive protein （hs-CRP） or lipoprotein-associate- ed phospholipase A2 （Lp-PLA2） in patients with coronary disease.Methods：Patients with acute coronary syndrome （ACS group, 39 males, 12 females, aged 63±10）, stable angina pectoris （SAP group, 28 males, 11 females, aged 63±9） and control subjects （CTL group, 23 males, 7 females, aged 59±7） were included in present study. Hs-CRP and Lp-PLA2 were assayed by ELSIA and coronary angiography （CAG） and IVUS/IVUS-VH were performed in all patients. The plaque compositions and features were accessed by IVUS-VH soft ware.Results：The levels of plasma Lp-PLA2 （P〈0.01） and hs-CRP （P〈0.05） in ACS group were significantly higher than those in SAP group, respectively; and also plasma Lp-PLA2 （P〈0.05）and hs-CRP（P〈0.05） in SAP group were remarkably higher than those in CTL group, respectively; More necrotic plaques were found in patients with ACS than patients with SAP （necrotic tissue percentage 33.26±9.90% versus 8.26±6.77%, P〈0.01） and thin cap fibroatheroma was 43% in ACS group and 10% in SAP group （P〈0.01）, there were positive correlations between percentage of the necrotic tissue and Lp-PLA2 （r=0.511, P=0.019） and hs-CRP （r=0.412, P=0.026）, and between the plaque remodeling index and Lp-PLA2 （r=0.567, P=0.012） and hs-CRP （r=0.402, P=0.043）. Conclusions：Plasma Lp-PLA2 is correlated with the vulnerable features of the coronary plaque; Lp-PLA2 may be at least similar or even superior to hs-CRP for predicting plaque vulnerability.