血管内超声评价妊娠相关蛋白A水平与不稳定性心绞痛罪犯病变形态的关系

Evaluation on the relationship between pregnancy associated plasma protein-A and intravascular ultrasound detected culprit coronary plaque morphology in patients with unstable angina

目的 探讨血清妊娠相关蛋白A（PAPP-A）水平与不稳定性心绞痛（UA）罪犯病变形态的关系.方法 对68例UA患者行冠状动脉造影和血管内超声检查,采用双抗体夹心酶联免疫吸附法测定血清PAPP-A水平.分析不同PAPP-A水平UA患者罪犯病变的斑块特征.结果 高危UA患者PAPP-A水平高于中低危UA患者[（19.9±20.1）mIU/L比（6.9±5.7）mIU/L,P=0.002].PAPP-A为11.0 mIU/L时,其判别高危UA的敏感度为78.6%,特异度为77.5%.高PAPP-A水平（PAPP-A≥11.0 mIU/L）患者罪犯病变处外弹力膜面积、斑块面积和斑块负荷均高于低PAPP-A水平（PAPP-A〈11.0 mIU/L）患者,正性重构、超声衰减斑块和斑块破裂的比例也均高于低PAPP-A水平患者（均P〈0.01）.多因素回归分析显示,PAPP-A水平≥11.0 mIU/L（OR=5.921,P=0.014）和超声衰减斑块（DR=7.541,P=0.038）是高危uA的独立预测因子.结论 血清PAPP-A水平与UA斑块不稳定有关.PAPP-A水平≥11.0 mIU/L和超声衰减斑块是高危UA的独立预测因子.

Objective To assess the relationship between pregnancy associated plasma protein-A （PAPP-A）and culprit coronary plaque morphology in patients with unstable angina（UA）.Methods Sixtyeight UA patients undergoing diagnostic coronary angiography and intravascular ultrasound were included in this study.A sandwich enzyme-linked immunosorbent assay technique was used to assay the circulating PAPP-A.Plaque characteristics of culprit lesion were analyzed for UA patients with various PAPP-A levels.Results PAPP-A level was significantly higher in high-risk UA than in non-high-risk UA[（19.9±20.1）mIU/L vs.（6.9 ±5.7）mIU/L,P=0.002].Optimal threshold of PAPP-A to prediet high-risk UA was determined as 11.0 mIU/L with a sensitivity of 78.6%and a specificity of 77.5%.Patients with higher PAPP-A level（≥11.0 mIU/L）was associated with larger external elastic membrane cross-sectional area,plaque area and more plaque burden compared with patients with lower PAPP-A Ievel（all P〈0.01）.Positive remodeling,attenuated plaque and plaque rupture were significantly more often in patients with higher PAPP-A than in patients with lower PAPP-A level（all P〈0.01）.PAPP-A≥11.0 mIU/L（OR=5.921,P=0.014）and attenuated plaque（OR=7.541,P=0.038）were independent risk predictors for high-risk UA.Conclusions PAPP-A was associated with instability of culprit plaque in UA patients.PAPP-A≥11.0 mIU/L and attenuated plaque were independent predictors for high-risk UA.