冠状动脉粥样硬化易损斑块与单核细胞趋化活性的相关性研究

A correlation study of monocyte chemotaxis and IVUS features of atherosclerotic plaques in the patients with angina pectoris

目的利用血管内超声(IVUS)探讨冠状动脉易损斑块与血中单核细胞趋化活性的相关性。方法对40例稳定型心绞痛(SAP)和40例不稳定型心绞痛(UAP)患者分别进行冠脉造影(CAG)和血管内超声(IVUS)检查。应用IVUS分别观察比较冠状动脉内斑块的性质,同时测量冠脉病变部位及其参考部位的血管外弹力膜面积(EEMA)、管腔面积(LA)、斑块面积(PA)及斑块负荷(PB%),并计算斑块的偏心指数(EI)及血管的重构指数(RI)。应用Transw ell小室检测两组患者血液中单核细胞的趋化活性。相关性分析IVUS检测指标与单核细胞活性的相关性。结果 IVUS检测显示,UAP组主要为脂质性斑块,约占50%(46/92),而SAP组主要为纤维性斑块,约占55%(46/83),脂质斑块仅占17%(14/83)。与SAP组比较,UAP组斑块负荷和血管重构指数显著增高(P均<0.01)。与SAP组的斑块相比较,UAP组的斑块具有较大的偏心性(P<0.05),不稳定斑块呈明显的正性重构,约占68%(27/40),而稳定斑块主要表现为负性重构,约占75%(30/40)。UAP组单核细胞趋化活性明显增强,单核细胞移动数量明显多于SAP组,差异有统计学意义(P<0.01)。相关性分析显示,IVUS测值PB与单核细胞趋化活性呈显著正相关(γ=0.52,P<0.01)。结论 IVUS能够准确地识别AS易损斑块。单核细胞趋化活性反映了粥样斑块的稳定性。

Objective To study the correlation between characteristics of unstable atherosclerotic plaques with intravascular ultrasound（IVUS） and monocyte chemotaxis.Methods Forty patients with stable angina pectoris（SAP） and forty patients with unstable angina pectoris（UAP） were enrolled into the study.Coronary arteriography（CAG） and IVUS were performed in all patients.IVUS was used to analyze the qualities of the plaques and measure the external elastic membrane（EEM） area,lumen area（LA）,plaque area（PA）and plaque burden（PB%） at both the lesion and the reference segments in the same vessel.The lumen eccentricity index（EI）and remodeling index（RI） were calculated.Peripheral monocyte chemotaxis was assayed by the transwell chamber.Results Soft lipid plaques were foundin 50% of patients with unstable angina,while the patients with stable angina mainly suffered from fibrous and mixed plaques（55%）,and only 17 % soft plaques.There were more eccentric plaques in the unstable than the stable groups（P〈0.05）,and EEMA,LA,PA and PB in the unstable plaques were larger than those of stable plaques（all P〈0.01）.A positive remodeling pattern was identified in 68%（27/40） unstable plaques while 75%（30/40） stable plaques showed negative remodeling.The average number of migrated monocytes measured in UAP patients were more than that in patients with SAP（P〈0.01）.The UAP group showed a higher activity of monocyte chemotaxis ability.PB measured with IVUS correlated well with monocytes chemotaxis（γ=0.52,P〈0.01）.Conclusions IVUS can detect unstable atherosclerotic plaques and predict plaque disruption in the early stage of atherosclerosis.Monocyte chemotaxis ability is associated with the stability of atherosclerotic plaques.