高敏C反应蛋白与易损斑块相关性的iMAP-血管内超声研究

Assessment for the Relationship Between hs-CRP and Vulnerable Plaques in Patients With Acute Coronary Syndrome by Intravascular Ultrasound

目的：通过iMAP-血管内超声（iMAP—IVUS）分析动脉粥样硬化斑块成分，探讨高敏C反应蛋白（hs—CRP）与易损斑块问的相关性。方法：连续筛选于我院心内科住院治疗，需接受择期冠状动脉（冠脉）造影（CAG）或经皮冠脉支架置入术并完成血管内超声（IVUS）的急性冠脉综合征（ACS）患者189例，所有患者于入院时检测hs—CRP，根据hs—CRP水平将患者分为两组：低水平组：hs—CRP≤3mg／L；高水平组：hs—CRP〉3mg／L，分析两组患者CAG及IVUS影像学结果。结果：①与低水平组患者相比，高水平组患者有更高的白细胞、肌酐、肌酸激酶MB同工酶（CK—MB）及B型利钠肽（BNP）水平（P〈0．05），其hs—CRP及超敏肌钙蛋白（cTnI）显著高于低水平组（P〈0．01）。②高水平组患者病变含有较少的钙化成分（P=O．002）、更多的坏死核心（P〈0．001）及更高的薄纤维帽斑块（TCFA）发生率（P=O．003）。③hs—CRP是TCFA的独立预测因子（比值比：2．457，95％CI：1．34～4．49，P=0．003）。结论：经iMAP～血管内超声证实，hs—CRP与ACS患者易损斑块有良好的相关性，可作为预测易损斑块的炎性标志物。

Objective： To assess the relationship between high sensitivity C-reactive protein （hs-CRP） and vulnerable plaques in patients with acute coronary syndrome （ACS） by intravascular ultrasound （IVUS）. Methods： A total of 189 ACS patients who received elective CAG, PCI and 1VUS in our hospital were analyzed. The hs-CRP level was examined at admission and the patients were divided into 2 groups. Low hs-CRP （43 mg/L） group, n=117 and High hs-CRP （〉3 mg/L） group, n=72. The CAG, IVUS imaging and hs-CRP levels were compared between 2 groups. Results： Compared with Low hs-CRP group, the High hs-CRP group presented significantly increased WBC, serum creatinine, creatine kinase MB （CK-MB）, BNP and cardiac troponin I （cTnl）, all P〈0.05. The plaques in High hs-CRP group had less calcification （P=0.002）, more necrosis in the core （P〈0.001） and more frequency of thin-cap fibroatheroma （TCFA） （P=0.003）. hs-CRP was an independent predictor of TCFA （OR=2.457, 95% CI 1.34-4.49, P=0.003）. Conclusion： IVUS indicated that hs-CRP is obviously related to vulnerable plaque component in ACS patients and it could be used as the inflammatory biomarker for vulnerable plaques.