急性冠状动脉综合征患者血小板表面细胞外基质金属蛋白酶诱导因子、糖蛋白Ⅵ水平与动脉粥样硬化斑块稳定性的关系

Relationship Between the Levels of Platelet Surface EMMPRIN, GPVI and the Stability of Coronary Plaque in Patients With Acute Coronary Syndrome

目的:探讨急性冠状动脉(冠脉)综合征患者血小板表面细胞外基质金属蛋白酶诱导因子(EMMPRIN)、糖蛋白Ⅵ(GPⅥ)的水平与动脉粥样硬化斑块稳定性的关系。方法:顺序选取138例冠心病患者,分为急性冠脉综合征组86例,稳定性心绞痛组52例,另选40例冠脉造影结果正常者为对照组。采用二次离心法提取血小板,流式细胞仪检测外周血血小板表面EMMPRIN和GPⅥ表达水平。为进一步研究,根据冠脉造影斑块形态特征分为Ⅰ、Ⅱ、Ⅲ型;并接受64层螺旋计算机断层摄影术(CT)冠脉成像检查,根据冠脉粥样斑块CT值分为软斑块、纤维斑块、钙化斑块,比较不同斑块形态及类型间EMMPRIN及GPⅥ表达水平变化。结果:(1)急性冠脉综合征组、稳定性心绞痛组血小板表面EMMPRIN、GPⅥ表达水平较对照组升高(EMMPRIN MFI:5.82±0.81、3.45±0.48 vs 1.35±0.15)、(GPⅥMFI:16.22±5.27、8.20±2.87 vs 4.14±1.17);且急性冠脉综合征组较稳定性心绞痛组升高明显,差异均有统计学意义(P均<0.05)。(2)急性冠脉综合征组Ⅱ型斑块者、Ⅲ斑块者血小板表面EMMPRIN、GPⅥ表达水平较I型斑块者升高(EMMPRIN MFI:6.35±1.05、4.09±0.67 vs 2.45±0.27)、(GPⅥMFI:19.50±4.55、10.81±2.33 vs 5.89±1.28);Ⅱ型斑块者较Ⅲ型斑块者也有明显升高,差异均有统计学意义(P均<0.05)。(3)急性冠脉综合征组软斑块者、纤维斑块者血小板表面EMMPRIN、GPⅥ表达水平较钙化斑块者升高(EMMPRIN MFI:6.18±1.01、3.87±0.56 vs 2.43±0.25)、(GPⅥMFI:19.14±4.27、11.08±1.94 vs 5.96±0.99);软斑块者较纤维斑块者也有明显升高,差异均有统计学意义(P均<0.05)。(4)冠心病患者血小板表面EMMPRIN表达水平与斑块类型[95%可信区间(CI):-0.359^-0.206,标准化的回归系数(β):-0.211]呈负相关,与临床类型(95%CI0.893~1.034,β:0.893)呈正相关,血小板表面GPⅥ表达水平与斑块类型(95%CI-1.222^-0.586,β:-0.181)呈负相关,与临床类型(95%CI 3.576~4.164,β:0.960)呈正相关。结论:急性冠脉综合征组患者血小板表面EMMPRIN、GPⅥ表达水平与动脉硬化斑块的稳定性关系密切,两者是严重冠脉病变的相关危险因素,对于动脉硬化早期的诊断可能有一定预测价值。

by lfow cytometry. According to CAG morphology, the plaques included 3 types as Type I, Type II and TypeⅢ. The patients also received coronary CT angiography （CTA）, upon CTA value, the plaques were classiifed by soft plaque, ifbrous plaque and calciifed plaque. Expressions of platelet surface EMMPRIN and GPVI among different groups were compared. Results：①Compared with Control group, ACS and SAP groups had increased expressions of EMMPRIN （5.82 ± 0.81 and 3.45 ± 0.48） vs （1.35 ± 0.15） and GPVI （16.22 ± 5.27 and 8.20 ± 2.87） vs （4.14 ±1.17）; the expressions in ACS group were higher than those in SAP group, allP〈0.05.②In ACS group, compared with Type I plaque, the patients with Type II and TypeⅢ plaques had elevated levels of EMMPRIN （6.35 ± 1.05 and 4.09 ± 0.67） vs （2.45 ± 0.27） and GPVI （19.50 ± 4.55 and 10.81 ± 2.33） vs （5.89 ± 1.28）; the expressions in patients with Type II plaque was higher than those with Type III plaque, allP〈0.05.③In ACS group, compared with calciifed plaque, the patients with soft and ifbrous plaques had the higher levels of EMMPRIN （6.18 ± 1.01 and 3.87 ± 0.56） vs （2.43 ± 0.25） and GPVI （19.14 ± 4.27 and 11.08 ± 1.94） vs （5.96 ± 0.99）; the expressions in patients with soft plaque was higher than those with ifbrous plaque, allP〈0.05.④In CAD patients, EMMPRIN expression was negatively related to plaque type （95% CI： -0.359 to -0.206, β： -0.211） and positively related to clinical type （95% CI： 0.893-1.034, β： 0.893）; GPVI expression was negatively related to plaque type （95% CI： -1.222 to -0.586, β： -0.181） and positively related to clinical type （95% CI： 3.576-4.164, β： 0.960）. Conclusion： Expression levels of platelet surface EMMPRIN and GPVI were closely related to the stability of coronary plaque, both of them were the risk factors for severe coronary lesions. EMMPRIN and GPVI may have certain predictive value for early diagnosis of arteriosclerosis in ACS patients.