血清妊娠相关蛋白-A预测冠状动脉临界病变斑块易损性的临床研究

Correlation Studies Between the Level of Plaque Vulnerability Serum Pregnancy-Associated Plasma Protein-A and Plaque Features of Prediction Coronary Intermediate Lesions

目的:探讨血清妊娠相关蛋白-A浓度在预测冠状动脉临界病变斑块易损性的作用。方法:入选临床冠心病患者150例,其中,冠状动脉狭窄处于临界病变的患者100例,冠状动脉造影正常者50例。分为不稳定斑块组(A组)56例和稳定斑块组(B组)44例,对照组(冠状动脉造影正常者,C组)50例,用酶联免疫吸附法测定三组患者血清妊娠相关蛋白-A浓度,用血管内超声成像(IVUS)评价稳定斑块和不稳定斑块冠状动脉斑块的形态、特征、稳定性,相关性分析评价血清妊娠相关蛋白-A浓度与冠状动脉临界病变斑块易损性的关系。结果:A组血清妊娠相关蛋白-A浓度显著高于B组及C组(均P<0.05),IVUS显示A组病变血管的偏心指数、重构指数、斑块面积脂核大小(P均<0.05)、斑块负荷(P<0.01)均明显大于B组,纤维帽厚度(P<0.01)及管腔面积(P<0.05)明显小于B组,血清PAPP-A水平与纤维帽厚度呈负相关(r=-0.386,P<0.01),与偏心指数(r=0.251,P<0.05)、重构指数(r=0.287,P<0.05)、脂核大小(r=0.310,P<0.05)呈显著正相关。结论:血清妊娠相关蛋白-A与IVUS评价冠状动脉临界病变斑块稳定性的指标成显著性相关,可作为评价冠状动脉临界病变斑块易损性的血液学指标。

Objective：To explore the role of the concentrations of pregnancy-associated plasma protein-A（PAPP-A） predict the vulnerability of the plaque in the coronary artery borderline lesions. Methods：100 patients with 150 patients enrolled in clinical coronary heart disease, which is a critical coronary stenosis disease, 50 patients with normal coronary angiography. Into the unstable plaque group（A group） and 56 cases of stable plaque group （group B） 44 patients in the control group（normal coronary angiography, group C） 50 cases, three groups of patients was measured by enzyme-linked immunohistochemical assay serum concentrations of pregnancy associated plasma protein-A, with intravascular ultrasound imaging （IVUS） evaluation the stable and unstable plaques morphology, features, stability, correlation analysis and evaluation of serum concentrations of pregnancy associated plasma protein-A and coronary heart disease plaque vulnerability relationship. Results：A serum pregnancy associated plasma protein-A concentrations were significantly higher in group B and group C （all P〈0.05）, IVUS Show A group of eccentric lesion index, remodeling index, the size of lipid core plaque area（P〈0.05）, plaque burden（P〈0.01） were significantly higher than group B, fibrous cap thickness（P〈0.01） and lumen area（P〈0.05） was significantly less than group B, serum PAPP-A levels and fibrous cap thickness negatively correlated （r=-0.386, P〈0.01）, and the eccentricity index （r=0.251, P〈0.05）, remodeling index （r=0.287, P〈0.05）, lipid core size （r=0.310, P〈0.05） were significantly positive correlation. Conclusions：Serum pregnancy associated plasma protein-A and IVUS evaluation of coronary plaque stability as critical lesions were significantly correlated, as a critical evaluation of coronary artery disease in hematological indicators of plaque vulnerability.