摘要
目的探讨血清炎性因子高敏C反应蛋白(hs-CRP)、血清甲壳质酶蛋白40(YKL-40)水平与冠状动脉病变斑块纤维帽厚度之间的相关性。方法入选择期行冠状动脉造影的冠心病患者60例,对其临床资料进行回顾性分析。根据冠心病的临床类型,将患者分为稳定型心绞痛(SAP)组(22例)、不稳定型心绞痛(UAP)组(28例)和急性心肌梗死(AMI)组(10例)。检测患者术前血清hs-CRP和YKL-40水平,术中在介入治疗前使用光学相干断层成像(OCT)观察病变斑块的特征,并分析血清hs-CRP、YKL-40水平与纤维脂质斑块纤维帽厚度之间的关系。结果 (1)AMI组术前血清hs-CRP和YKL-40水平均高于SAP组和UAP组(P均<0.05)。UAP组术前血清hs-CRP和YKL-40水平均高于SAP组(P均<0.05)。(2)AMI组和UAP组的罪犯病变纤维脂质斑块纤维帽厚度均小于SAP组(P均<0.05),AMI组与UAP组之间的罪犯病变纤维脂质斑块纤维帽厚度差异无统计学意义(P>0.05)。AMI组薄纤维帽斑块的比率和血栓形成的比率均高于SAP组和UAP组(P均<0.05);AMI组斑块内钙化的比率低于SAP组(P>0.05),与UAP组之间差异无统计学意义(P>0.05)。(3)Pearson相关分析显示,术前血清hs-CRP(r=-0.265,P<0.05)和YKL-40(r=-0.524,P<0.01)水平与纤维脂质斑块纤维帽厚度均呈负相关;Spearman相关分析显示,术前血清hs-CRP和YKL-40水平与冠心病患者斑块破裂(r=0.462和r=0.499,P<0.01)和血栓形成(r=0.218和r=0.263,P<0.01)呈正相关。(4)多因素Logistic回归分析显示,血清YKL-40水平与薄纤维帽粥样斑块独立相关(OR=6.341,P<0.05)。结论 AMI和UAP患者的血清hs-CRP和YKL-40水平均高于SAP患者,AMI、UAP和SAP患者罪犯病变的纤维脂质斑块性质有明显差别,AMI患者出现薄纤维帽粥样斑块、斑块破裂及血栓形成的比例较高,而SAP患者出现斑块钙化的比例较高;血清YKL-40水平与冠心病患者罪犯病变的薄纤维帽粥样斑块形成独立相关。
Aim To identify the correlation between chitinase protein 40 (YKL-40) levels including high sensitive C reactive protein (hs-CRP) and the fibrous cap thickness of fibrofatty plaque in coronary culprit 1esions. Methods Clinical data of 60 patients with selective coronary artery angiography diagnosed coronary artery disease were retrospectively analyzed. According to type of coronary disease, patients were divided into 3 subgroups:SAP group (containing 22 stable angina patients), UAP group (containing 28 unstable angina patients), and AMI group (containing 10 acute myocardial infarction patients). Serum hs-CRP and YKL-40 levels were measured before subsequent procedures. The characteristics of the culprit lesions were detected by optical coherence tomography (OCT) before interventional treatment, and the correlation between hs-CRP, YKL-40 and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were analyzed. Results (1)The serum levels of hs-CRP and YKL-40 were significantly higher in AMI group than in SAP and UAP group (all P<0.05), and higher in UAP group than in SAP group (all P<0.05).(2)The fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were smaller in AMI and UAP group than in SAP group (all P<0.05), and there was no significant difference between AMI group and UAP group (P>0.05). Proportion of thin-cap fibroatheroma plaque (all P<0.05), plaque rupture and thrombosis were significantly higher in AMI group than in SAP and UAP group (all P<0.05). Proportion of calcification in plaque was lower in AMI group than in SAP group (P<0.05), and there was no significant difference between AMI group and UAP group (P>0.05).(3)Pearson correlation analysis showed that serum levels of hs-CRP (r=-0.265, P<0.05) and YKL-40 (r=-0.524, P<0.01) were negatively correlated with fibrous cap thickness of fibrofatty plaques. Spearman correlation analysis showed that serum levels of hs-CRP and YKL-40 were positively correlated with plaque rupture (r=0.462 and r=0.499, P<0.01) and thrombosis (r=0.218 and r=0.263, P<0.05).(4)Multiple Logistic regression analysis showed that serum levels of YKL-40 at baseline was independently related to thin-cap fibroatheroma plaque (OR=6.341, P<0.01). Conclusions The serum levels of hs-CRP and YKL-40 in AMI patients were much higher than that in SAP and UAP patients, higher in UAP patients than in SAP patients. Prevalence of thin-cap fibroatheroma plaque, plaque rupture and thrombosis was significantly higher in the AMI patients, while the prevalence of calcification in plaque was more often in SAP patients. Increased serum levels of YKL-40 were independent risk factor of thin-cap fibroatheroma plaque formation.
作者
倪占玲
杨宏辉
陈岩
张优
高传玉
NI Zhanling;YANG Honghui;CHEN Yan;ZHANG You;GAO Chuanyu(Department of Cardiology, Fuwai Central China Cardiovascular Hospital & Heart Centre of Henan Provincial People,s Hospital,Zhengzhou, Henan 450008 , China)
出处
《中国动脉硬化杂志》
CAS
2019年第4期288-292,共5页
Chinese Journal of Arteriosclerosis
基金
河南省卫生计生委员会科技攻关项目(201602265)
关键词
冠心病
甲壳质酶蛋白40
动脉粥样硬化
易损斑块
coronary heart disease
chitinase protein 40
atherosclerosis
vulnerable plaque
