非 ST 段抬高型急性冠状动脉综合征患者血清血管活性因子与斑块形态的关系。

Relationship between serum vasoactive factors and plaque morphology in patients with non-ST-segment elevated acute coronary syndrome.

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing 100029, China.

出版信息

Chin Med J (Engl). 2010 Jan 20;123(2):193-7.

PMID:20137369

Abstract

BACKGROUND

Vasoactive factors have been reported to correlate with vulnerable plaque and acute coronary syndrome (ACS). This study aimed to investigate the relationship between vasoactive factors and plaque morphology in patients suffering from non-ST-segment elevated ACS.

METHODS

From April 2007 to April 2009, 124 consecutive patients suffering from non-ST-segment elevated ACS who had received coronary angiography (CAG) and intravascular ultrasound (IVUS) in the People's Liberation Army General Hospital and Beijing Anzhen Hospital were enrolled in this study. Three serum vasoactive factors, plasma soluble vascular endothelial growth factor receptor-1 (sFlt-1), placental growth factor (PLGF) and interleukin-18 (IL-18), were measured by enzyme-linked-immunosorbent serologic assay of the patients. The levels of vasoactive factors were compared between vulnerable plaque group and stable plaque group, and between unstable angina pectoris (UAP) group and non-ST-segment elevation acute myocardial infarction (NSTE-AMI) group. The relationship between the plaque morphology and levels of vasoactive factors was analyzed.

RESULTS

The levels of vasoactive factors were similar between the UAP group (69 patients) and NSTE-AMI group (55 patients). The levels of sFlt-1 and PLGF in the vulnerable plaque group were significantly higher than those in the stable plaque group. The level of IL-18 was correlated positively with plaque morphology. Multivariate Logistic regression analysis showed that the level of PLGF was an independent risk factor for vulnerable plaque (OR=2.115, 95% CI 1.415-5.758, P=0.018). Using the ROC curve, PLGF was a significant factor for the diagnosis of vulnerable plaque (the diagnostic point was 26.3 ng/L, the proportion of square area under the ROC curve was 0.799, 95%CI 0.758-0.839, P<0.001; the sensitivity of PLGF under the ROC curve was 86%, and the specificity 63%).

CONCLUSION

Both IL-18 and PLGF are biomarkers for vulnerable plaques and helpful to predict vulnerable plaque.

摘要

背景

已有研究表明，血管活性因子与易损斑块和急性冠状动脉综合征（ACS）相关。本研究旨在探讨非 ST 段抬高型 ACS 患者血管活性因子与斑块形态之间的关系。

方法

连续入选 2007 年 4 月至 2009 年 4 月于解放军总医院和北京安贞医院行冠状动脉造影（CAG）和血管内超声（IVUS）检查的 124 例非 ST 段抬高型 ACS 患者，酶联免疫吸附法检测患者 3 种血清血管活性因子：血浆可溶性血管内皮生长因子受体-1（sFlt-1）、胎盘生长因子（PLGF）和白细胞介素-18（IL-18）。比较易损斑块组与稳定斑块组、不稳定型心绞痛（UAP）组与非 ST 段抬高型急性心肌梗死（NSTE-AMI）组间血管活性因子水平的差异，分析斑块形态与血管活性因子水平的关系。

结果

UAP 组（69 例）与 NSTE-AMI 组（55 例）血管活性因子水平相似。易损斑块组 sFlt-1 和 PLGF 水平显著高于稳定斑块组。IL-18 水平与斑块形态呈正相关。多因素 Logistic 回归分析显示，PLGF 水平是易损斑块的独立危险因素（OR=2.115，95%CI 1.415~~5.758，P=0.018）。ROC 曲线分析显示，PLGF 对易损斑块的诊断具有显著意义（诊断界点为 26.3ng/L，ROC 曲线下面积为 0.799，95%CI 0.758~~0.839，P<0.001；PLGF 在 ROC 曲线下的敏感度为 86%，特异度为 63%）。