64层CTA结合血清MMP-9、sCD40L评价冠脉临界病变斑块成分及稳定性

Study on atherosclerotic plaque composition in patients with intermediate coronary stenosis by multidetector computed tomography angiography,serum matrix metalloproteinase 9 and soluble CD40 ligand

目的:通过64层计算机体层摄影冠状动脉血管造影识别冠状动脉临界病变患者的冠脉斑块成分,并检测血清基质金属蛋白酶-9(MMP-9)、可溶性CD40配体(sCD40L)水平,探讨其斑块稳定性及临床意义。方法:选择经64层计算机体层摄影冠状动脉血管造影证实至少有1支冠脉某一阶段狭窄30%～70%的患者65例,其中稳定型心绞痛36例,不稳定型心绞痛29例,通过斑块CT值及冠脉管腔碘造影剂CT值确定其斑块类型:非钙化斑块,钙化斑块和混合斑块;并用ELISA方法测定患者及37例无心血管疾病对照组血清MMP-9、sCD40L水平,比较其差异性并探讨其相互关系。结果:冠脉临界病变患者混合斑块最多,其次为非钙化斑块,钙化斑块最少,"混合斑块+非钙化斑块"显著多于钙化斑块数目;患者血清MMP-9、sCD40L水平显著高于无心血管疾病对照组。结论:冠心病冠脉临界病变斑块多为易损斑块。

AIM： To study the atherosclerotic plaque composition in patients with intermediate coronary stenosis using multidetector computed tomography angiography（MDCTA） and to explore the relationship between serum matrix metalloproteinase 9,soluble CD40 ligand level and plaque composition.METHODS： Enrolled in the study were 65 patients aged（62±8） years,including 36 patients aged（61±1） years with stable angina pectoris（SAP） and 29 patients age（64±8） years with unstable angina pectoris（UAP） with at least one segment of coronary diameter stenosis 30%-70% confirmed by contrast-enhanced 64-DCTA.Plaque composition in coronary arteries was determined by plaque CT value based on Hounsfield units（HU）： noncalcified,calcified,or mixed,and serum MMP-9 and sCD40L expressions were measured in both patients and 37 volunteers age（46±15） years without coronary heart disease（CHD）.RESULTS： Plaques found in patients with intermediate coronary stenosis were mixed（118,46%）,noncalcified（85,33%） and calcified（54,21%） and the number of mixed plus noncalcified was significantly higher than the number of calcified（P0.05）.The levels of serum MMP-9 and sCD40L were higher in patients and lower in volunteers without CHD（P0.01,P0.05）.CONCLUSION： Patients with intermediate coronary stenosis have a higher burden of mixed and noncalcified plaques and higher activities of serum MMP-9 and sCD40L.Thus,it is important to stabilize the vulnerable plaques so as to prevent and reduce acute cardiovascular events.