复杂冠状动脉狭窄与不稳定型心绞痛及斑块炎症程度之间的关联。

Association between complex coronary artery stenosis and unstable angina and the extent of plaque inflammation.

作者信息

Meuwissen Martijn, van der Wal Allard C, Koch Karel T, van der Loos Chris M, Chamuleau Steven A J, Teeling Peter, de Winter Robbert J, Tijssen Jan G P, Becker Anton E, Piek Jan J

机构信息

Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

出版信息

Am J Med. 2003 May;114(7):521-7. doi: 10.1016/s0002-9343(03)00078-0.

DOI:10.1016/s0002-9343(03)00078-0

PMID:12753875

Abstract

PURPOSE

Patients with unstable coronary syndromes often have complex morphology of coronary stenoses at angiography. We evaluated the association between qualitative assessment of coronary stenoses and plaque inflammation determined by immunohistochemistry.

METHODS

A total of 79 patients with unstable (n = 46) or stable angina (n = 33) underwent directional coronary atherectomy for culprit lesions. Qualitative analysis of coronary angiograms was performed using a modified Ambrose classification. Coronary lesions were categorized as either simple (concentric and eccentric type I, n = 29) or complex (eccentric type II and multiple irregularities, n = 50). Cryostat sections of retrieved atherosclerotic specimens were stained immunohistochemically with monoclonal antibodies, alpha-actin (smooth muscle cells), CD68 (macrophages), and CD3 (T lymphocytes). The extent of atherosclerotic inflammation within each coronary lesion was determined by the percentage of immunopositive macrophages per total tissue area (including smooth muscle cells) and the number of T lymphocytes per mm(2).

RESULTS

The mean (+/- SD) percentage of macrophages in atherectomy specimens from patients with unstable angina was greater than in specimens from patients with stable angina (21% +/- 14% vs. 13% +/- 10%, P = 0.01); similar results were seen when complex coronary lesions were compared with simple lesions (23% +/- 13% vs. 9% +/- 8%, P <0.001). In multivariate linear regression models, the combination of unstable angina and lesion complexity was strongly associated with the percentage of plaque macrophages.

CONCLUSION

The extent of atherosclerotic plaque inflammation is associated with angiographic grading of coronary lesion complexity and unstable angina.

摘要

目的

不稳定型冠状动脉综合征患者在血管造影时冠状动脉狭窄形态常较复杂。我们评估了冠状动脉狭窄的定性评估与免疫组织化学测定的斑块炎症之间的关联。

方法

总共79例不稳定型心绞痛（n = 46）或稳定型心绞痛（n = 33）患者因罪犯病变接受了冠状动脉定向旋切术。使用改良的安布罗斯分类法对冠状动脉造影进行定性分析。冠状动脉病变分为简单病变（同心和偏心I型，n = 29）或复杂病变（偏心II型和多个不规则病变，n = 50）。对取回的动脉粥样硬化标本的低温切片用单克隆抗体α-肌动蛋白（平滑肌细胞）、CD68（巨噬细胞）和CD3（T淋巴细胞）进行免疫组织化学染色。通过每个冠状动脉病变内免疫阳性巨噬细胞占总组织面积（包括平滑肌细胞）的百分比以及每平方毫米T淋巴细胞的数量来确定动脉粥样硬化炎症的程度。

结果

不稳定型心绞痛患者旋切标本中巨噬细胞的平均（±标准差）百分比高于稳定型心绞痛患者的标本（21%±14%对13%±10%，P = 0.01）；当比较复杂冠状动脉病变与简单病变时也观察到类似结果（23%±13%对9%±8%，P<0.001）。在多变量线性回归模型中，不稳定型心绞痛和病变复杂性的组合与斑块巨噬细胞百分比密切相关。