冠状动脉粥样硬化斑块特性的早期识别及药物干预对血清学指标的影响

Early identification of characteristics of coronary atherosclerotic plaques and effect of medication on serological markers

目的通过影像学技术对冠状动脉粥样硬化斑块的特性进行早期识别,并观察药物治疗对血清学指标的影响。方法选取2016年4月至2017年5月在新疆维吾尔自治区喀什地区第二人民医院接受诊治的100例冠状动脉粥样硬化性心脏病患者。其中稳定型心绞痛(SAP)患者50例(SAP组),急性冠状动脉综合征(ACS)患者50例(ACS组)。经冠状动脉造影、血管内超声和血管内超声-虚拟组织学技术分析斑块特性。同时检测患者血清高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、高迁移率族蛋白1(HMGB1)水平。结果 ACS组总胆固醇、低密度脂蛋白胆固醇水平高于SAP组,高密度脂蛋白胆固醇水平低于SAP组,差异均有统计学意义(均P <0. 05)。ACS组软斑块、破裂斑块患者比例明显高于SAP组[72. 0%(36/50)比36. 0%(18/50)、76. 0%(38/50)比12. 0%(6/50)],差异均有统计学意义(均P <0. 05)。ACS组患者中斑块成分为纤维脂质和坏死核心成分者比例高于SAP组,钙化组织者比例低于SAP组[(21. 4±4. 5)%比(14. 6±3. 8)%、(17. 4±4. 2)%比(8. 3±3. 2)%、(10. 6±2. 4)%比(19. 3±3. 7)%],差异均有统计学意义(均P <0. 05)。治疗前ACS组的血清hs-CRP、IL-6、HMGB1水平高于SAP组,治疗2个月后ACS组以上指标下降幅度大于SAP组,差异有统计学意义(P <0. 05)。结论 ACS患者的斑块纤维脂质和坏死核心成分比例较高,积极给予他汀药物干预可改善患者炎症程度。

Objective To observe the characteristics of coronary atherosclerotic plaques by imaging technology and to analyze the effect of medication on serum indicators. Methods From April 2016 to May 2017, 100 patients with coronary atherosderotic heart disease were enrolled in Kashgar Prefecture Second People′s Hospital, Xinjiang Uygur Autonomous Region. There were 50 patients with stable angina pectoris(SAP) and 50 patients with acute coronary syndrome(ACS). Characteristics of coronary plaques were analyzed by coronary angiography, intravascular ultrasound and intravascular ultrasound-virtual histology. Serum levels of high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6) and high mobility group protein 1(HMGB1) were measured. Results Levels of total cholesterol and low density lipoprotein cholesterol in ACS group were significantly higher and high density lipoprotein cholesterol was lower than those in SAP group(P<0.05). Ratios of patients with soft plaque and ruptured plaque in ACS group were significantly higher than those in SAP group[72.0%(36/50) vs 36.0%(18/50), 76.0%(38/50) vs 12.0%(6/50)](P<0.05). Ratios of fibrous lipids and necrotic core were significantly higher and the ratio of calcified tissue was significantly lower in ACS group than those in SAP group[(21.4±4.5)% vs (14.6±3.8)%, (17.4±4.2)% vs (8.3±3.2)%,(10.6±2.4)% vs (19.3±3.7)%](P<0.05). Serum levels of hs-CRP, IL-6 and HMGB1 in ACS group were significantly higher than those in SAP group before treatment(P<0.05). Two months after treatment, the drop ranges of serum indicators in ACS group were significantly greater than those in SAP group(P<0.05). Conclusions ACS patients have high ratios of fibrous lipids and necrotic core components in atherosclerotic plaques. Statins can reduce the inflammation in patients with coronary atherosclerosis.