iMap^TM血管内超声检测冠状动脉粥样斑块坏死核心与心血管疾病危险因素、Lp-PLA2相关性

The relationship of coronary atherosclerotic plaque necrosis core measured by iMap^(TM) intravascular ultrasound to cardiovascular disease risk factors and LP-PLA2

目的探讨传统心血管疾病危险因素及脂蛋白相关磷脂酶A2(Lp-PLA2)与冠状动脉粥样硬化斑块坏死核心(NC)的关系。方法 2015年6月至2017年6月连续入选经冠状动脉造影示原位冠状动脉狭窄(40%～70%)患者,定量冠状动脉造影(QCA)和iMap^(TM)血管内超声(IVUS)检测靶病变最小管腔直径(MLD)、病变长度(LL)、面积狭窄率(AS),iMap^(TM)IVUS检测靶病变最狭窄处外弹力膜横截面面积(EEMCSA)、最小管腔横截面面积(MLACSA)、斑块面积(PA)、斑块负荷(PB)及参考段EEMCSA(REEMCSA)、参考段MLACSA(RMLACSA),并检测靶病变NC面积及其占斑块总面积百分比。多因素线性回归法分析传统危险因素、LP-PLA2与NC关系。结果与QCA检测比较,iMap^(TM)IVUS检测靶病变LL更长[(21.46±5.80) mm对(24.71±5.33) mm,P<0.05],AS更高[(58.21±6.57)%对(62.29±8.02)%,P<0.05]。心血管危险因素分析显示,LDL-C与PB呈正相关(P<0.05),HDL-C与NC所占百分比呈负相关(P>0.05),Lp-PLA2、LDL-C、伴糖尿病与NC所占百分比呈正相关(P<0.05)。多因素线性回归分析显示,伴糖尿病、LDL-C、Lp-PLA2是NC所占百分比的独立危险因素。结论 LDL-C与冠状动脉粥样斑块PB呈正相关,HDL-C与NC呈负相关。伴糖尿病、LDL-C、Lp-PLA2是斑块稳定性危险因素,与NC呈正相关。

Objective To investigate the relationship of the conventional coronary risk factors and lipoprotein-associated phospholipase A2(LP-PLA2) to the necrosis core(NC) of coronary atherosclerotic plaque. Methods A total of 88 successive patients with symptomatic myocardial ischemia, who were admitted to authors’ hospital during the period from June 2015 to June 2017 and whose coronary arteriongraphy showed coronary stenosis in situ(40%-70%), were enrolled in this study. Quantitative coronary angiography(QCA) and iMapTM intravascular ultrasound(IVUS) were used to measure the minimum lumen diameter(MLD), lesion length(LL) and area stenosis rate(AS), and iMapTM IVUS was used to measure the external elastic membrane cross-sectional area(EEMCSA), the minimum lumen cross section area(MLACSA), the plaque area(PA), the plaque burden(PB), the reference segment EEMCSA(REEMCSA) and the reference segment MLACSA(RMLACSA) at the narrowest part of the lesions. Target lesion NC area and its percentage of the total plaque area were calculated. By using multivariate linear regression analysis method to evaluate the relationship of NC to the conventional risk factors and LP-PLA2.Results Compared with QCA, LL of target lesions detected by i Map IVUS was longer [(21.46±5.80) mm vs(24.71±5.33) mm,P<0.05], and AS of target lesions detected by i Map IVUS was higher [(58.21±6.57)% vs(62.29 ±8.02)%,P <0.05]. The analysis of cardiovascular risks indicated that a positive correlation existed between LDL-C and PB(P<0.05), a negative correlation existed between HDL-C and the percentage of NC(P<0.05), and Lp-PLA2, LDL-C, coexisting diabetes bore a positive relationship to the percentage of NC(P<0.05). Multivariate linear regression analysis showed that coexisting diabetes, LDL-C and Lp-PLA2 were independent risk factors for the percentage of NC. Conclusion LDL-C is positively correlated with PB,HDL-C is negatively correlated with the percentage of coronary atherosclerotic plaque NC. Coexisting diabetes, LDL-C and LP-PLA2 are risk factors for coronary plaque stability and are positively correlated with atherosclerotic plaque NC.