颈动脉斑块和sCD40L与急性冠状动脉综合征近期预后的关系

Relation of carotid plaque, sCD40L and recent prognosis in patients with ACS

目的 探讨超声下颈动脉斑块和sCD40L与急性冠状动脉综合征（ACS）近期预后的关系.方法 随机入选79例ACS患者,包括预后良好组（58例）和预后不良组（21例）.用超声检查颈动脉斑块特点,并用ELISA法检测血清sCD40L含量,观察预后不良的ACS患者颈动脉斑块和血清sCD40L的变化.用Pearson相关性分析ACS患者颈动脉斑块与血清sCD40L水平的关系.用Logistic回归研究颈动脉斑块与血清sCD40L是否是ACS近期预后不良的独立预测因子.结果 与预后良好组比较,预后不良组ACS患者颈动脉软斑发生率（76％比50％）、颈动脉复合斑块低回声面积比[（45.98％±10.15）％比（25.64±5.89）％]、血清sCD40L[（16.22±3.15）ng/ml比（11.12±1.91）ng/ml]升高（P＜0.05）.ACS患者颈动脉复合斑块低回声面积比与血清sCD40L水平呈正相关（r=0.622,P=0.000）.颈动脉复合斑块低回声面积比与血清sCD40L上调（OR分别为2.73、2.39,P＜0.05）是ACS近期预后不良的独立预测因子.结论 超声发现颈动脉复合斑块低回声面积比和血清sCD40L升高对ACS近期预后不良有预测价值.

Objective To investigate the the predictive value of recent prognosis in patients with ACS by carotid plaque and sCD40L.Methods 79 patients with acute coronary syndrome （ACS）,divided into good prognosis group （n=58） and poor prognosis group （n=21）,were radomly selected.The patients were detected the carotid plaque by ultrasonic testing and the serum sCD40L by ELISA.Relation of carotid plaque and serum sCD40L were analized by using Pearson correlation.Whether carotid plaque and serum sCD40L could be independent predictor of ACS with poor prognosis or not was analized by Logistic regression.Results Compared with good prognosis group,the incidence of soft carotid plaque,low echo area percentage of carotid artery composite plaque and serum sCD40L increased in poor prognosis group [50％ vs 76％,（25.64±5.89）％ vs （45.98±10.15）％,（11.12±1.91）ng/ml vs （16.22±3.15）ng/ml,all P＜0.05].Pearson correlation analysis indicted that low echo area percentage of carotid artery composite plaque was positively associated with the level of serum sCD40L in ACS patients （r=0.622,P=0.000）.The upregulation of low echo area percentage of carotid artery composite plaque and serum sCD40L were independent predictors of ACS with poor prognosis （OR=2.73 and 2.39,P=0.025 and 0.032,respectively）.Conclusion The upregulation of low echo area percentage of carotid artery composite plaque and serum sCD40L have predictive value for ACS with poor prognosis.