超敏C反应蛋白、前基质金属蛋白酶-1、基质金属蛋白酶组织抑制因子-1与冠状动脉斑块形态的关系：血管内超声研究

Relationship between hs-CRP, proMMP-1, TIMP-1 and coronary plaque morphology: intravascular ultrasound study.

作者信息

Zhang Xing-wei, Ge Jun-bo, Yang Jian-min, Ge Lei, Wang Ning-fu, Gao Yan, Li Pei-zhang, Pan Hao, Tong Guo-xin, Zhou Liang, Ye Xian-hua, Xu Jian

机构信息

Department of Cardiology, Hangzhou First Municipal Hospital & Hangzhou Hospital, Nanjing Medical University, Hangzhou 310006, China.

出版信息

Chin Med J (Engl). 2006 Oct 20;119(20):1689-94.

PMID:17097015

Abstract

BACKGROUND

Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome (ACS). It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein (hs-CRP), pro-matrix metalloproteinase-1 (proMMP-1), tissue inhibitors of matrix metalloproteinase-1 (TIMP-1) and coronary plaque morphology.

METHODS

Intravascular ultrasound (IVUS) examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area (EEM CSA), plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner fabric-cap, smaller minimal lumen cross-sectional area (MLA), dissection and thrombus were significantly more frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group. hs-CRP > 8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval (CI), 67.0% - 85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% (P < 0.01), similarly for proMMP-1 > 0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2% - 80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% (P < 0.01), and TIMP-1 > 83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2% - 78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% (P < 0.01).

CONCLUSION

The plaque characteristics correlate with the clinical presentation. The elevation of hs-CRP, proMMP-1 and TIMP-1 are related to the plaque instability and rupture.

摘要

背景

不稳定斑块破裂并随后形成血栓是急性冠状动脉综合征（ACS）常见的病理生理基础。探索预测斑块特征的血液指标具有潜在意义。很少有研究聚焦于该领域。因此，我们研究了超敏C反应蛋白（hs-CRP）、基质金属蛋白酶原-1（proMMP-1）、基质金属蛋白酶组织抑制剂-1（TIMP-1）与冠状动脉斑块形态之间的关系。

方法

对2003年2月至2005年7月期间152例确诊冠心病且拟行经皮冠状动脉介入治疗的患者进行血管内超声（IVUS）检查。在手术前采集动脉血的血浆样本。分别采用酶联免疫吸附测定（ELISA）法测定hs-CRP、proMMP-1和TIMP-1的水平。

结果

急性心肌梗死和不稳定型心绞痛患者中不稳定和破裂斑块更为常见。破裂和不稳定斑块组的外弹力膜横截面积（EEM CSA）、斑块面积、脂质池面积和斑块负荷显著更大。破裂和不稳定斑块组中阳性重构、纤维帽更薄、最小管腔横截面积（MLA）更小、夹层和血栓更为常见。破裂斑块组的血浆hs-CRP、proMMP-1和TIMP-1水平更高。以hs-CRP>8.94 mg/L预测破裂斑块，ROC曲线面积为0.76 [95%置信区间（CI），67.0% - 85.8%]，敏感性为71.8%，特异性为77.0%，准确性为69.2%（P<0.01）；proMMP-1>0.12 ng/ml时，ROC曲线面积为0.69 [95% CI，58.2% - 80.2%]，敏感性为69.2%，特异性为75.2%，准确性为66.2%（P<0.01）；TIMP-1>83.45 ng/ml时，ROC曲线面积为0.67 [95% CI，56.2% - 78.3%]，敏感性为66.7%，特异性为61.9%，准确性为66.2%（P<0.01）。