冠状动脉性心脏病患者血浆铜蓝蛋白与冠状动脉斑块稳定性的相关性

Relationship between ceruloplasmin and coronary plaque stability in patients with coronary heart disease

目的探讨急性冠状动脉综合征(ACS)和稳定型心绞痛(SAP)患者血浆铜蓝蛋白(CP)水平与冠状动脉斑块稳定性之间的关系。方法选择行冠状动脉造影(CAG)和血管内超声(IVUS)检查的ACS患者103例和SAP患者76例,选取57例经CAG检查排除冠状动脉性心脏病(CHD)的患者作为对照组。所有患者均于CAG前抽取静脉血5mL,采用免疫散射比浊法检测血浆CP和超敏C-反应蛋白(hs-CRP)水平。179例患者中158例行虚拟组织学血管内超声(VH-IVUS)检查,根据检查结果再次分为斑块破裂组31例、薄纤维帽斑块(TCFA)组75例和非薄纤维帽斑块(non-TCFA)组52例。选择管腔狭窄程度最严重和坏死核心最大的切面进行IVUS相关参数测量。结果 ACS组的血浆CP和hs-CRP水平均显著高于SAP组和对照组(P值均<0.01)。斑块破裂组和TCFA组的血浆CP和hs-CRP水平均显著高于non-TCFA组(P值均<0.01)。在罪犯血管最小管腔面积处,ACS组IVUS纤维脂质百分比显著小于SAP组(P<0.01),而坏死组织百分比显著大于SAP组(P<0.01),且两组坏死组织百分比与血浆CP水平均呈正相关(r=0.46、0.52,P值均<0.05)。结论血浆CP可成为反映CHD患者冠状动脉斑块稳定性的指标。

Objective To investigate the relationship between ceruloplasmin and coronary plaque stability in patients with acute coronary syndrome （ACS） and stable angina pectoris （SAP）. Methods In this retrospective study, 103 patients with ACS and 76 patients with SAP, who were diagnosed by coronary angiography （CAG） and intravascular ultrasound （IVUS） were enrolled. Meanwhile, 57 patients without coronary heart disease （CHD） confirmed by CAG were assigned to control group. Venous blood 5 mL was collected before CAG for detecting ceruloplasmin and hypertensitive C reactive protein （hs-CRP） concentrations. Gray-scale IVUS and virtual histology intravascular ultrasound （VH-IVUS） were used to analyze the culprit lesions. Based on the gray-scale IVUS and VH-IVUS findings, lesions were divided into 3 groups., ruptured plaque group （n = 31 ） , thin cap fibrous atheromatous （TCFA） plaque group （n = 75） and non-TCFA plaque group （n = 52）. The minimum lumen site and the largest necrotic core site were chosen to determine IVUS related parameters. Results The concentrations of ceruloplasmin and hs-ORP in ACS group were significantly higher than those in SAP group and control group （both P^0. 01 ）. The concentrations of ceruloplasmin and hs-CRP in non-TCFA group were remarkably lower than those TCFA plaque group and ruptured plaque group （both P 〈 0.01 ）. ACS group had smaller percentages of fibrofatty plaque areas and greater percentages of necrotic core areas in ACS group as compared with SAP group （both P〈0.01 ）, and ceruloplasmin level had a positive correlation with the percentage of necrotic core in both groups （ r = 0.46, 0.52, both P 〈 0. 05）. Conclusion Plasma ceruloplasmin is an independent predictor of vulnerable plaques in CHD patients.