血浆组织蛋白酶 S 和胱抑素 C 水平与轻中度病变冠状动脉斑块形态的关系：应用血管内超声的体内研究。

Relationship between plasma cathepsin S and cystatin C levels and coronary plaque morphology of mild to moderate lesions: an in vivo study using intravascular ultrasound.

机构信息

Heart Center, China Meitan General Hospital, Beijing, China.

出版信息

Chin Med J (Engl). 2009 Dec 5;122(23):2820-6.

PMID:20092784

Abstract

BACKGROUND

Cathepsin S and its endogenous inhibitor cystatin C are implicated in the pathogenesis of atherosclerosis, especially in the plaque destabilization and rupture leading to acute coronary syndrome. However, whether circulating cathepsin S and cystatin C also change in association with coronary plaque morphology is unknown yet.

METHODS

We recruited 98 patients with unstable angina (UA, n = 6) or stable angina (SA, n = 2) who had a segmental stenosis resulting in > 20% and < 70% diameter reduction in one major coronary artery on coronary angiography. Thirty-one healthy subjects served as controls. Intravascular ultrasound (IVUS) was used to evaluate plaque morphology. Plasma cathepsin S and cystatin C were measured as well.

RESULTS

At the culprit lesion site, plaque area ((7.85 +/- 2.83) mm(2) vs (6.53 +/- 2.92) mm(2), P = 0.027), plaque burden ((60.92 +/- 11.04)% vs (53.87 +/- 17.52)%, P = 0.025), remodeling index (0.93 +/- 0.16 vs 0.86 +/- 0.10, P = 0.004) and eccentricity index (0.74 +/- 0.17 vs 0.66 +/- 0.21, P = 0.038) were bigger in UA group than in SA group. Plasma cathepsin S and cystatin C were significantly higher in patients than in controls (P < 0.01). Plasma cathepsin S was higher in UA group ((0.411 +/- 0.121) nmol/L) than in SA group ((0.355 +/- 0.099) nmol/L, P = 0.007), so did the plasma cystatin C ((0.95 +/- 0.23) mg/L in UA group, (0.84 +/- 0.22) mg/L in SA group; P = 0.009). Plasma cathepsin S positively correlated with remodeling index (r = 0.402, P = 0.002) and eccentricity index (r = 0.441, P = 0.001), and plasma cystatin C positively correlated with plaque area (r = 0.467, P < 0.001) and plaque burden (r = 0.395, P = 0.003) in UA group but not in SA group.

CONCLUSIONS

Plasma cathepsin S and cystatin C increased significantly in UA patients. In angina patients, higher plasma cathepsin S may suggest the presence of vulnerable plaque, and higher plasma cystatin C may be a clue for larger atherosclerotic coronary plaque.

摘要

背景

组织蛋白酶 S 及其内源性抑制剂半胱氨酸蛋白酶抑制剂 C 与动脉粥样硬化的发病机制有关，尤其是在斑块不稳定和破裂导致急性冠状动脉综合征方面。然而，循环中的组织蛋白酶 S 和半胱氨酸蛋白酶抑制剂 C 是否也会随着冠状动脉斑块形态的变化而改变，目前尚不清楚。

方法

我们招募了 98 名不稳定型心绞痛（UA，n=6）或稳定型心绞痛（SA，n=2）患者，这些患者的冠状动脉造影显示，一条主要冠状动脉的节段性狭窄导致>20%且<70%的直径减少。31 名健康受试者作为对照组。采用血管内超声（IVUS）评估斑块形态。测量血浆组织蛋白酶 S 和半胱氨酸蛋白酶抑制剂 C。

结果

在罪犯病变部位，斑块面积（[7.85±2.83]mm²对[6.53±2.92]mm²，P=0.027）、斑块负荷（[60.92±11.04]%对[53.87±17.52]%，P=0.025）、重构指数（0.93±0.16 对 0.86±0.10，P=0.004）和偏心指数（0.74±0.17 对 0.66±0.21，P=0.038）在 UA 组中明显大于 SA 组。与对照组相比，患者的血浆组织蛋白酶 S 和半胱氨酸蛋白酶抑制剂 C 均明显升高（P<0.01）。与 SA 组相比，UA 组的血浆组织蛋白酶 S 水平更高（[0.411±0.121]nmol/L），差异有统计学意义（P=0.007），血浆半胱氨酸蛋白酶抑制剂 C 水平也更高（[0.95±0.23]mg/L 对[0.84±0.22]mg/L，P=0.009）。UA 组中，血浆组织蛋白酶 S 与重构指数（r=0.402，P=0.002）和偏心指数（r=0.441，P=0.001）呈正相关，与斑块面积（r=0.467，P<0.001）和斑块负荷（r=0.395，P=0.003）呈正相关，但在 SA 组中无相关性。