冠状动脉临界病变粥样硬化易损性斑块血管内超声特征及分子机制的研究

Intravascular ultrasound features of intermediate coronary arterial lesions and the relationship of fractalkine, CD36 and LP-PLA2 with coronary artery stenosis

目的探讨不稳定型心绞痛患者冠状动脉临界病变粥样斑块的血管内超声特征及外周血CD36、Fractalkine及LP—PLA2水平变化与冠脉病变程度的关系。方法选择不稳定型心绞痛患者120例，根据冠状动脉造影结果分为：严重病变组（管腔狭窄率〉70％）40例及临界病变组（管腔狭窄50％～70％）80例。应用血管内超声检测两组患者冠脉斑块的性质、外弹力膜面积（EEMA）、管腔面积（LA）、斑块面积（PA）、斑块负荷（PB）及血管重构指数等并指导冠脉介入治疗。ELISA法测定血清CD36、Fractalkine及LP—PLA2水平。结果血管内超声发现临界病变组主要为脂质斑块，约占74％，严重病变组脂质斑块约为48％（P〈0．01）；严重病变组病变部位血管的EEMA、PA及PB明显大于临界病变组（P〈0．05～O．01），两组患者的病变部位斑块均以偏心斑块为主，均呈现为正性重构。临界病变组进行介入治疗者共59例（74％），介入治疗组病变部位血管的EEMA、PA、PB及RI明显大于非介入组（P〈0．05～0．01）。临界病变组与严重病变组CD36水平差异有统计学意义（P〈O．05）。结论不稳定型心绞痛患者的临界病变具有典型的易损斑块的特征，血管内超声能够指导冠脉的介入治疗。CD36可以作为评价冠状动脉粥样硬化斑块严重性的指标。

Objective To elucidate the clinical application value of intravaseular ultrasound（IVUS） in assessing intermediate lesions and the relationship between serum levels of fractalkine,CD36 and LP-PLA2 and severity of coronary artery atherosclerosis. Methods One hundred and twenty patients with unstable angina underwent coronary angiography. Then the patients were divided into two groups ： severe lesion group （lumen diameter stenosis greater than 70% ,including 40 patients） ,and the intermediate lesion group lumen diameter stenosis（50% -70%,80 patients）. IVUS were performed in all patients to analysis the coronary lesions. Concentrations of CD36, fractalkine and LP-PLA2 were measured by means of ELISA. Results IVUS found that 74% intermediate lesion patients had soft lipid plaques,while 48% severe lesion patients had lipid plaques （ P 〈0.01）. Patients with severe lesion had larger plaque burden and vascular remodeling index than those of patients with intermediate lesions（ P 〈0.05-0.01）. There were 59 patients（74%） in the intermediate lesion group underwent PCI. IVUS also found the PCI patients had larger plaque burden and vascular remodeling index. Concentration of CD36 was significantly higher in severe lesion group than that of intermediate lesion group （ P d0.05）. Conclusions IVUS could further clarify the characteristics of the intermediate and severe lesions, and provide guidance for PCI treatment. Plasma CD36 level could be used to predict pathological severity of coronary atherosclerosis.