血清脂蛋白(a)水平与血管内超声斑块显像特征的关系

Relationship of virtual histological features of coronary atherosclerotic plaques and lipoprotein(a)

目的观察不同类型冠心病患者血清脂蛋白(a)[Lp(a)]水平及在血管内超声(IVUS)下冠状动脉斑块显像特征关系。方法选择在我院住院急性冠状动脉综合征(ACS)患者88例,稳定型心绞痛(SAP)患者72例,同时选取在门诊因胸痛就诊,行冠状动脉造影显示正常的患者80例作为对照组,测定三组患者血清Lp(a)水平,应用IVUS评价ACS组和SAP组患者冠状动脉斑块的形态、特征及易损性。并进一步评价血清Lp(a)与IVUS评价易损性斑块指标的相关性。结果 ACS组血清Lp(a)浓度显著高于SAP组及对照组(均P<0.01),ACS组狭窄病变处主要为软斑块、偏心性斑块,而SAP组则反之,ACS组IVUS斑块面积(P<0.01)、偏心指数及重构指数(P均<0.05)均大于SAP组,管腔面积小于SAP组(P<0.01),血浆Lp(a)水平与软斑块面积百分比、偏心指数和血管重构指数(r=0.365,P=0.011;r=0.448,P=0.008和r=0.432,P<0.001)呈正相关。结论 ACS组血清Lp(a)水平明显高于SAP组和对照组,血清Lp(a)水平与IVUS评价斑块易损性指标相关,Lp(a)可作为冠状动脉易损斑块的评估因子。

Objective To assess the relationship of coronary atherosclerotic plaques detected by intravascular ultrasound（IVUS） and virtual histological imagining（IVUS-VH） with plasma lipoprotein（a） in patients with coronary disease. Methods Patients with acute coronary syndrome（ACS group）, stable angina pectoris（SAP group） and control subjects（CTL） group were included in present study. Lipoprotein（a） were assayed by immunoturbidimetry. Coronary angiography（CAG） and IVUS/IVUS-VH were performed in all patients. The plaque compositions and features were assessed by IVUS-VH software. Results The levels of plasma lipoprotein（a） in ACS were remarkably higher than those in SAP group and CTL group;. More soft plaques were found in patients with ACS group than patients with SAP group（P〈0.01）. Compared with SAP group, lumen area significantly（P〈0.01） decreased, remodeling index（RI） （P〈0.05）, eccentricity index（EI） （P〈0.05） and plaque area （PA） （P〈0.01）significantly increased. There were positive correlations between percentage of soft plaque and lipoprotein（a） （r=0.365, P=0.011）, and between the plaque remodeling index and lipoprotein（a） （r=0.432, P〈0.001）, and between the EI and lipoprotein（a） （r=0.448, P=0.008）. Conclusion Plasma lipoprotein（a） is correlated with the vulnerable features of the coronary plaque. The elevation of lipoprotein（a） may correlate with the plaque instability and rupture.