血管内超声特征结合血清MCP-1对冠心病冠状动脉斑块稳定性及预后的评估

Assessment of IVUS characteristics combined with serum MCP-1 to the stability and prognosis of coronary artery plaque

目的:研究血管内超声(IVUS)特征结合血清单核细胞趋化蛋白-1(MCP-1)对冠心病冠状动脉斑块稳定性及预后的评估。方法:选取医院收治的120例冠心病患者,按照患者病情类型将其分为稳定型心绞痛(SA)组和不稳定型心绞痛(UA)组,每组60例,所有患者均行IVUS检查以及血清MCP-1检测,比较两组患者的IVUS特征以及血清MCP-1差异,分析IVUS特征及血清MCP-1与斑块稳定性以及不良心血管事件的相关性。结果:两组患者的年龄、性别、体重指数、吸烟史、高血压史、糖尿病史、血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)水平的差异均无统计学意义;SA组患者的血管外弹力膜横截面积(EEMCSA)、斑块负荷、脂核大小、重构指数、破裂斑块及易损斑块均显著低于UA组,差异有统计学意义(t=3.557,t=18.038,t=14.748,t=1.338,t=126.797,t=26.008;P<0.05);SA组患者的最小管腔横截面积(MLACSA)、纤维帽厚度及稳定斑块均显著高于UA组,差异有统计学意义(t=17.837,t=4.819,t=266.638;P<0.05);SA组患者发生死亡、心肌梗死以及各种血管重建的情况显著低于UA组,差异有统计学意义(x^(2)=4.321,x^(2)=6.982,x^(2)=4.901;P<0.05);SA组患者MCP-1水平为(52.69±2.33)pg/ml,显著低于UA组患者的(81.36±6.23)pg/ml;冠心病患者的冠状动脉斑块不稳定性以及不良心血管事件与患者的冠状动脉斑块EEMCSA、斑块负荷、脂核大小、重构指数、MCP-1呈现正相关,与MLACSA、纤维帽厚度呈现负相关。结论:IVUS特征以及血清MCP-1对冠心病冠状动脉斑块稳定性及不良心血管事件具有显著相关性,可作为日后诊断的重要依据。

Objective:To study the assessment of intravenous ultrasound(IVUS)characteristics combined with serum monocyte chemoattractant protein-1(MCP-1)on the stability and prognosis of coronary artery plaques in coronary heart disease(CHD).Methods:120 patients with coronary heart disease admitted to hospital were selected and were divided into stable angina pectoris(SA)group and unstable angina pectoris(UA)group according to their condition types,with 60 cases in each group.All patients underwent IVUS examination and serum MCP-1 test,and the differences of IVUS characteristics and serum MCP-1 between the two groups of patients were compared.And the IVUS characteristics,the correlations of serum MCP-1 with plaque stability and with adverse cardiovascular events were analyzed.Results:The differences of age,gender,body mass index(BMI),history of smoking,history of hypertension,history of diabetes,serum triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)between two groups were not significant.The extravascular elastic membrane cross-sectional area(EEM CSA),plaque load,lipid nucleus size,remodeling index,ruptured plaques and vulnerable plaques of SA group were significantly lower than those of UA group,the differences of them between two groups were statistically significant(t=3.557,t=18.038,t=14.748,t=1.338,t=126.797,t=26.008,P<0.05).The minimum lumen cross-sectional area(MLA CSA),fiber cap thickness and stable plaque of SA group were significantly higher than those of UA group(t=17.837,t=4.819,t=266.638,P<0.05).The death,myocardial infarction and various vascular remodeling of SA group were significantly lower than those of UA group(x2=4.321,x2=6.982,x2=4.901,P<0.05).The MCP-1 level of SA group was(52.69±2.33)pg/ml,which was significantly lower than(81.36±6.23)pg/ml of patients in UA group.The instability of coronary artery plaques and adverse cardiovascular events in patients with CHD were positively relative to the EEM CSA of patient’s coronary arterial plaque,plaque load,lipid nucleus size,remodeling index and MCP-1,respectively.And it was negative correlation with MLA CSA and fibrous cap thickness.Conclusion:IVUS characteristics and serum MCP-1 have significantly correlation with the stability of CHD coronary plaque and adverse cardiovascular event.And it can be used as important reference in the diagnosis of future.