应用血管内超声评价高敏C反应蛋白与不稳定型心绞痛患者冠状动脉斑块性质的相关性

The correlation study between coronary artery plaque properties and high-sensitivity c-reactive protein in unstable angina pectoris by intravascular ultrasound

目的探讨不稳定型心绞痛患者冠状动脉罪犯病变血管内超声虚拟组织学斑块显像特征与血清高敏C反应蛋白(hypersensitive C-reactiveprotein,hs-CRP)的关系。方法回顾性分析确诊为冠心病并且同意行冠状动脉造影(CAG)和血管内超声检查(intravascular ultrasound, IVUS)的患者资料,应用统计方法,以稳定型心绞痛(SAP)患者组为对照组,不稳定型心绞痛(UAP)患者为观察组,分析UAP患者血管内超声下斑块形态学特征与血清hs-CRP水平的相关性。结果入选研究对象共56例,其中UAP患者组34例,SAP患者组22例。两组患者在冠心病危险因素和病变部位比较差异无统计学意义(P>0.05)。两组的斑块病变对比中,UAP组斑块病变的脂质池面积、斑块脂质比和斑块偏心指数显著大于SAP组,差异有统计学意义(P<0.05);而UAP组与SAP组在外弹力膜面积、最小管腔直径、狭窄率、斑块负荷、斑块面积、斑块纤维帽厚度、重构指数、血管直径、管腔直径等测量指标差异无统计学意义(P>0.05)。两组血清hs-CRP水平比较差异有统计学意义(P<0.01);UAP患者组斑块病变的脂质池面积和斑块脂质比与血清hs-CRP值呈正相关(r=0.377、0.320,P<0.05)。结论 UAP患者斑块病变脂质池面积、斑块脂质比及斑块偏心指数与SAP患者有显著差异。其血清hs-CRP水平也显著高于后者,UAP患者斑块不稳定性与血清hs-CRP水平密切相关,提示血清hs-CRP是评估UAP患者病情变化的重要检测指标。

Objective To investigate the correlation between hypersensitive C-reactive protein(hs-CRP) and the features of virtual histological plaque imaging of coronary artery lesions in patients with unstable angina. Methods A retrospective study was performed between January 2015 and December 2016 in patients, who were diagnosed with coronary heart disease at the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine and received coronary arteriography(CAG) and intravascular ultrasound(IVUS). Stable angina(SAP) patients were selected as control group, and unstable angina(UAP) patients as the experimental group. The correlation between morphological characteristics of plaques under intravascular ultrasound and serum hs-CRP levels were analyzed. Results A total of 56 subjects were enrolled in this study, including 34 patients in the UAP group and 22 patients in the SAP group. There was no significant difference in the risk factors and lesions of coronary heart disease between the two groups(P>0.05). In the comparison of plaque lesions in the two groups, the lipid pool area, plaque lipid ratio, and plaque eccentricity index of the plaque lesions in the UAP group were significantly greater than those in the SAP group(P<0.05). There was no significant difference in measurement indexes between the UAP group and SAP group in the external elastic membrane area, the smallest chamber diameter, stenosis rate, plaque load, plaque area, plaque fibrous cap thickness, reconstruction index, blood vessel diameter or lumen diameter(P>0.05). There was significant difference in serum hs-CRP between the two groups(P<0.01). The lipid pool area and plaque lipid ratio of plaque lesions in UAP patients was positively correlated with serum hs-CRP(r=0.377 and 0.320, P<0.05). Conclusion The lipid pool area, plaque lipid ratio and plaque eccentricity index of UAP patients are significantly different from those of SAP patients. Serum hs-CRP level of the former is also significantly higher than that of the latter. Plaque instability in UAP patients is closely correlated to serum hs-CRP, suggesting that serum hs-CRP is an important detection index to assess the condition changes of UAP patients.