颈动脉斑块形态学与血浆炎症介质的关系研究

Relation study between the carotid artery plaque morphology and plasma inflammatory mediators

目的从颈动脉粥样硬化斑块的形态学改变,结合测定血浆炎症介质水平综合评价斑块的易损性。方法对68例首次发病的脑梗死患者(A组)、62例无症状颈动脉硬化患者(B组)和56例健康对照者(C组)进行研究,超声检查颈动脉内膜中层厚度(IMT)及斑块类型,采用酶联免疫吸附法检测血浆高敏C反应蛋白(hs-CRP)、基质金属蛋白酶(MMP,包括MMP-2、MMP-9)、CD40配体(CD40L)水平,并A组患者行神经功能缺损程度评分。结果 A组IMT高于B组(P<0.05)。与无斑块和稳定斑块患者相比较,易损斑块患者在血浆hs-CRP、MMP-2、MMP-9、CD40L水平较高(P<0.05)。A组患者血浆hs-CRP、MMP-2、MMP-9、CD40L水平均高于B组(P<0.05)。易损斑块者血浆hs-CRP水平与MMP-2、MMP-9呈正相关;MMP-2水平与MMP-9、CD40L呈正相关;MMP-9与CD40L呈正相关。A组患者血浆hs-CRP、MMP-2、MMP-9、CD40L与神经功能缺损程度评分均呈正相关。结论超声检查结合检测血浆炎症介质水平有助于判断颈动脉硬化斑块的易损性。

Objective To evaluate the vulnerability of carotid artery plaque by the morphological changes of carotid atherosclerotic plaques and levels of plasma inflammatory markers.Methods 68 cases of patients with the first attacking cerebral infarction（group A）,62 cases with asymptomatic carotid atherosclerosis（group B） and 55 normal controls（group C） were investigated.The intima-medial thickness（IMT）,plaque type were detected or calculated respectively by Ultrasonic inspection,then the plasma levels of high sensilive C-reactive protein（hs-CRP）,matrix metalloproteinase（MMP,including MMP-2 and MMP-9） and CD40 liqand（CD40L） were measured by ELISA.The patients of group A were evaluated with neurologic impairment scale.Results Compared with group B,IMT of group A was higher（P 0.05）.The plasma levels of hs-CRP,MMP-2,MMP-9 and CD40L of vulnerable plaque patients were higher than those of no plaque and stable plaque patients（P 0.05）.The plasma levels of hs-CRP,MMP-2,MMP-9 and CD40L of group A were higher than those of group B and group C（P 0.05）.Among the vulnerable plague patients,correlation analysis manifested that there were positive correlation between levels of hs-CRP and MMP-2,MMP-9;there were positive correlation between MMP-2 and MMP-9,CD40L;there was a positive correlation between MMP-9 and CD40L.NFDS had positive correlation with hs-CRP,MMP-2,MMP-9,CD40L levels of group A.Conclusion Ultrasonic inspection combined with detection of plasma levels of inflammatory mediators are helpful with judging the vulnerability of carotid artery plaques.