血清血小板源性生长因子与冠状动脉粥样硬化斑块超声显像特征的关系研究

Correlation Study Between Serum Platelet Derived Growth Factor Level and Ultrasound Imaging Features of Coronary Atherosclerotic Plaques in Relevant Patients

目的:采用血管内超声(IVUS)技术检测不同类型冠心病患者冠状动脉内粥样硬化斑块的性质及其与血清血小板源性生长因子(PDGF)的关系研究。方法:选取2011-01至2013-10期间胜利油田中心医院住院并行冠状动脉造影检查的患者106例作为研究对象,其中急性冠状动脉综合征患者(ACS组)60例,稳定性心绞痛患者(SAP组)46例。记录患者性别、年龄、吸烟史、高血压病史、糖尿病病史等基本资料,采用双抗体夹心酶联免疫吸附法(ELISA法)检测患者血清PDGF水平。同时对两组患者进行IVUS检查,详细记录罪犯血管最狭窄处冠状动脉粥样斑块形态、性质、斑块破裂、血栓形成、重构情况以及病变处外弹力膜面积、管腔面积、斑块面积、偏心指数等。比较两组斑块性质、斑块破裂和血栓形成发生率、正性重构比率以及外弹力膜面积、偏心指数等的差异,以及不同斑块性质血清PDGF水平的差异。结果:(1)SAP组血清PDGF浓度为(3.64±0.60)ng/L显著高于ACS组(2.12±0.51)ng/L,两组比较差异有统计学意义(P<0.05)。(2)SAP组患者冠状动脉病变以硬斑块为主,ACS组患者斑块以软斑块为主。与SAP组比较,ACS组患者斑块破裂、血栓形成、正性重构发生率高,且ACS组较SAP组斑块以偏心斑块为主,偏心指数低,差异均有统计学意义(P<0.05~0.01)。与SAP组比较,ACS组患者病变血管外弹力膜面积较大,差异有统计学差异(P<0.01)。(3)纤维斑块、钙化斑块、混合斑块(硬斑块)血清PDGF水平均低于软斑块,差异有统计学意义(P<0.05~0.01)。结论:PDGF参与冠状动脉粥样硬化斑块的形成,在ACS的发病中起着重要作用,斑块越不稳定,PDGF的浓度越高,检测血清PDGF水平有助于诊断和预测ACS的发生,使ACS的诊断流程和治疗策略的选择更趋于合理和规范。

Objective： To detect the features of atherosclerotic plaques and their correlation to serum platelet derived growth factor （PDGF） level in patients with different types of coronary artery disease （CAD） by intravascular ultrasound （IVUS）. Methods： A total of 106 patients admitted in our hospital with coronary angiography from 2011-01 to 2013-10 were enrolled and divided into 2 groups： Acute coronary syndrome （ACS） group,n=60 and Stable angina pectoris （SAP） group, n=46. Basic information as gender, age, history of smoking, hypertension and diabetes were recorded in all patients; serum levels of PDGF were measured by ELISA. IVUS was conducted to examine coronary atherosclerotic plaque morphology, property, rupture, thrombosis and refactoring in criminal vessels; meanwhile, external elastic membrane area, lumen area, plaque area and eccentric index were determined at the lesion site. The above parameters were compared between 2 groups and the correlation of different types of plaques to serum levels of PDGF were studied. Results：①Serum PDGF level in SAP group was higher than ACS group （3.64±0.60） ng/L vs （2.12±0.51） ng/L,P〈0.05.②The patients in SPA group were mainly having hard plaque and in ACS group were mainly having soft plaque. Compared with SAP group, ACS group had the higher incidences of plaque rupture, thrombosis and positive refactoring; ACS group was＆nbsp;mainly with eccentric plaque with low eccentric index allP〈0.05-0.01; ACS group had the larger external elastic membrane area at the lesion site,P〈0.05.③The patients with fibrous plaque, calcified plaque and mixed plaque （hard plaque） had the lower serum levels of PDGF than those with soft plaque,P〈0.05. Conclusion： PDGF had been involved in atherosclerotic plaque formation and it played an important role in ACS pathogenesis. The patients with unstable plaques had the higher serum PDGF level, therefore PDGF detection may help ACS diagnosis and prediction.