非ST段抬高型急性冠脉综合征患者血清胱抑素C、高敏C反应蛋白水平与冠状动脉斑块易损性的关系

Relationship between serum cystatin C level, hs-CRP and virtual histology-intravascular ultrasound characteristics of culprit vessels in patients with non-ST-segment elevation acute coronary syndromes

目的 探讨非ST段抬高型急性冠脉综合征（NSTE-ACS）患者血清胱抑素C、高敏C反应蛋白（hs-CRP）水平与冠状动脉罪犯病变虚拟组织学-血管内超声（VH-IVUS）显像特征的相关性.方法 根据临床症状、心电图、肌钙蛋白I入选NSTE-ACS患者54例（NSTE-ACS组）和稳定型心绞痛（SA）患者34例（SA组）,采用乳胶增强免疫比浊法测定入选患者血清胱抑素C水平.依据心电图中ST-T发生改变的导联、超声心动图中出现室壁运动异常的部位,结合冠状动脉造影检查发现复杂病变的部位,综合确定罪犯血管病变.对所有病变进行IVUS影像定量分析,测量计算最小管腔处外弹力膜面积、最小管腔面积、斑块截面积、斑块负荷及坏死核心面积百分比,然后将NSTE-ACS患者血清中胱抑素C、hs-CRP水平与罪犯病变VH-IVUS特点进行相关性分析.结果 ①与SA组相比,NSTE-ACS组血清胱抑素C水平[（1.46±0.22）mg/L比（1.20±0.19）mg/L]明显升高,hs-CRP水平[（4.86±1.73）mg/L比（2.71±3.25）mg/L]明显升高,差异有统计学意义（P＜0.01）.②与SA组比较,NSTE-ACS组罪犯病变斑块负荷[（73.26±3.13）％比（69.28±5.97）％]、斑块截面积[（10.19±0.77）mm2比（9.14±1.3）mm2]、坏死核心成分比例[（14.83±4.47）％比（9.66±3.65）％]均明显升高,差异有统计学意义（P＜0.01或P＜0.05）.③NSTE-ACS组血清胱抑素C水平与hs-CRP、斑块负荷、坏死核心成分比例呈正相关（r值分别为0.410、0.463和0.823,均P＜0.01）;与HDL-C呈负相关（r=-0.491,P＜0.01）;血清hs-CRP水平与斑块负荷、斑块截面积、坏死核心成分比例呈正相关（r值分别为0.501、0.462和0.683,均P＜0.01）.结论 NSTE-ACS患者胱抑素C、hs-CRP水平与罪犯病变斑块的不稳定性密切相关,提示血清胱抑素C水平可以作为预测NSTE-ACS患者斑块破裂风险的一项指标.

Objective To observe the correlation of serum cystatin C level, hs-CRP and virtual histology-intravascular ultrasound characteristics of culprit vessels in patients with non-ST-segment elevation acute coro- nary syndromes （NSTE-ACS）. Methods 88 patients were divided into two groups according to the clinical characteristics： NSTE-ACS group（n=54） with NSTE-ACS and SA group（n=34） with SA. All patients underwent coronary angiography and virtual histology-intravascular ultrasound. Serum levels of cystatin C and hs-CRP were measured respectively. Culprit vessels were identified by comprehensive assessment including ST-T changes of ECG, ventricular wall motion abnormality of ultrasound examination and the complex lesion diagnosed by coronary an- giography. An quantitative estimation with virtual histology intravascular ultrasound of all 54 culprit lesions in NSTE-ACS group and all 34 culprit lesions in SA group included external elastic membrane, minimal luminal area, plaque area, plaque burden, percentages of necrotic core. Then their correlations were analyzed. Results （1）There were significant differences in levels of cystatin C [ （1.46±0.22）mg/L vs （1.20±0.19）mg/L] and hs-CRP [ （4.86±1.73）mg/L vs （2.71±3.25）mg/L] between the two groups （all P〈O.O1 ）. The serum levels of cystatin C and hs-CRP were significantly increased in NSTE-ACS group. （2）The plaque burden [ （73.26±3.13）% vs （69.28±5.97）% ], plaque area [（10.19±0.77）mm2 vs （9.14±1.3）mm2] and necrotic core percentage of culprit lesions [ （14.83±4.47）% vs （9.66±3.65）% ] in NSTE-ACS group was significantly higher than those of SA group（P〈0.05 or P〈0.01 ）. （3）Correlation analysis showed that, the serum level of cystatin C was positively correlated with hs- CRP, plaque burden and necrotic core percentage（r=0.410,0.463,0.823, all P〈0.01 ）, and was negatively corre- lated with HDL-C（r=-0.491, P〈0.01 ）. The serum level of hs-CRP was positively correlated with plaque burden, plaque area and necrotic core percentage（r=0.501,0.462,0.683, all P〈0.01）. Conclusion The serum cystatin C level is significantly increased in patients with NSTE-ACS, and it was associated with unstable composition of necrotic core of culprit vessels. The serum eystatin C level can be used for evaluating the stability of coronary lesions in patients with non-ST-segment elevation acute coronary syndromes.