梗死相关动脉粥样斑块的虚拟组织学特点与妊娠相关血浆蛋白A的相关性研究

Characteristics of virtual histology-intravascular unltrasound of infarction-related artery atheromatous plaque and pregnancy-associated plasma protein A level:a correlation study

目的对比分析急性心肌梗死相关动脉粥样斑块和稳定性心绞痛症状相关病变的虚拟组织学特点,研究虚拟组织学特点和妊娠相关血浆蛋白A的关系,探讨急性心肌梗死发病的炎症机制。方法 2008年1月至2009年12月入住武警医学院附属医院的急性ST抬高性心肌梗死并行直接介入治疗患者70例,随机选取同期介入治疗的稳定性心绞痛患者70例为对照。完成冠状动脉造影之后,导入ZEEK抽吸导管至症状相关病变,抽取冠状动脉血,集中用酶联免疫法测定妊娠相关血浆蛋白A水平,然后按标准方法对症状相关动脉行血管内超声检查,保存普通灰阶图像和虚拟组织学超声数据。分析斑块的虚拟组织学特点及与妊娠相关血浆蛋白A的相关性。结果两组患者年龄,性别,合并高血压、吸烟、糖尿病、高脂血症等临床资料差异无统计学意义(P>0.05),对照组和急性心肌梗死组虚拟组织学血管内超声特点不同,急性心肌梗死组纤维脂质成份和坏死组织明显增多,钙化成份少。对照组和急性心肌梗死组的坏死组织/钙化组织面积比值分别为(3.62±1.46)和(7.18±2.53),两组间差异有统计学意义(P<0.01)。急性心肌梗死组妊娠相关血浆蛋白A显著高于对照组(P<0.01),且斑块的虚拟组织学参数与妊娠相关血浆蛋白A有相关性(P<0.05或P<0.01)。结论急性心肌梗死相关动脉粥样斑块的虚拟组织学特点为坏死成份多,坏死/钙化面积比值大,与妊娠相关血浆蛋白A有很好相关性。

Objective To observe the characteristics of virtual histology-intravascular ultrasound（VH-IVUS） in 70 patients with acute ST segment elevated type myocardial infarction（AMI）,the findingswere compared with that in 70 patients with stable angina（control group）,and to analyze the correlationbetween VH-IVUS characteristics and pregnancy-associated plasma protein A（PAPPA） level.MethodsSeventy patients with ST segment elevated AMI and 70 patients with stable angina,who receivedpercutaneous coronary artery intervention and were encountered from Jan.2008 to Dec.2009,were involvedin this study.After coronary angiography was completed,the plasma was aspirated from culprit coronaryartery with ZEEK catheter.Then,IVUS examination to culprit lesion was carried out and grayscale and VHdata were stored.The characteristics of VH-IVUS of culprit atheromatous plaque were observed and itscorrelation with PAPPA was analyzed.Results The difference in age,gender,hypertension,smoking,diabetes mellitus and hyperlipidemia between two groups was of no statistical significance,but statisticallysignificant difference in VH-IVUS characteristics of the atheromatous plaque existed between two groups,more fibro-fatty tissue and necrotic tissue with less dense calcium were seen in AMI group.The ratio ofnecrotic tissue area to calcified tissue area was（3.62±1.46） in AMI group and（7.18±2.53） in control group（P0.01）.PAPPA in AMI group wassignificantly higher than that in control group（P0.01）.Parameters of VH-IVUS in AMIgroup were highly correlated with PAPPA（P0.05 or P0.01）.Conclusion The characteristics of virtual histology-intravascular ultrasound of infarction-related artery atheromatous plaqueinclude more necrotic tissue,higher ratio of necrotic tissue area to calcified tissue area and a closercorrelation with PAPPA.