[血清中可溶性分化簇40配体、基质金属蛋白酶9及妊娠相关血浆蛋白A水平与颈动脉斑块稳定性的关系研究]

[Research on the relationship between levels of soluble cluster of differentiation 40 ligand, matrix metalloproteinase 9 and pregnancy-associated plasma protein A in serum and stability of carotid plaques].

作者信息

Han Yi-peng, Wang Da-ming, Liu Jia-chun, Wang Li-jun, Lu Jun, Qi Peng, Li Shu-yu, Liu Bai-yun

机构信息

Department of Neurosurgery, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2012 Jan 1;50(1):70-3.

PMID:22490296

Abstract

OBJECTIVES

To study the relationship between serum levels of some inflammatory markers and stability of carotid plaques in the patients with carotid plaques and evaluate the ability of each serum marker in identifying vulnerable carotid plaques.

METHODS

The study included 65 consecutive patients with carotid plaques confirmed by imaging examinations from March 2008 to March 2010. All the patients were classified as stable plaques group (n = 21) and unstable plaques group (n = 44) according to the characteristic findings of the plaques in MRI such as the thickness of fibrous cap, the existence of large lipid core and the intra-plaque hemorrhage. The patients of unstable plaques group were further classified as unruptured plaques group (n = 29) and rupture plaques group (n = 15) according to the integrity of fibrous cap. Serum levels of soluble cluster of differentiation 40 ligand (sCD40L), matrix metalloproteinase 9 (MMP-9) and pregnancy-associated plasma protein A (PAPP-A) were determined by ELISA.

RESULTS

Serum levels of sCD40L and MMP-9 in patients of unstable plaques group, unruptured plaques group and rupture plaques group were all significantly enhanced compared to individuals of stable plaques group (SCD40L: χ(2) = 6.45, 12.04 and 16.23, P < 0.01; MMP-9; F = 2.55, 5.10 and 4.69, P < 0.05). Serum levels of PAPP-A in patients of unstable plaques group and rupture plaques group were all significantly enhanced compared to individuals of stable plaques group (χ(2) = 11.71 and 13.55, P < 0.05). Serum levels of PAPP-A in patients of rupture plaques group were significantly enhanced compared to individuals of unruptured plaques group (χ(2) = 13.19, P = 0.000). sCD40L ≥ 673.22 ng/L (OR = 22.47, 95%CI: 2.11 - 239.81, P = 0.010), MMP-9 ≥ 84.09 µg/L (OR = 10.01, 95%CI: 1.74 - 57.78, P = 0.010) and PAPP-A ≥ 0.101 µg/L (OR = 14.29, 95%CI: 2.69 - 75.90, P = 0.002) were all significantly correlated with the vulnerability of carotid plaques.

CONCLUSIONS

There appear to be a relationship between the serum levels of sCD40L, MMP-9 and PAPP-A and the stability of carotid plaques in patients with carotid plaques. High serum levels of the above-mentioned markers may indicate that the plaques were vulnerable or ruptured.

摘要

目的

研究颈动脉斑块患者血清中某些炎症标志物水平与颈动脉斑块稳定性之间的关系，并评估各血清标志物识别易损性颈动脉斑块的能力。

方法

本研究纳入了2008年3月至2010年3月期间经影像学检查确诊的65例连续颈动脉斑块患者。根据MRI中斑块的特征性表现，如纤维帽厚度、大脂质核心的存在及斑块内出血情况，将所有患者分为稳定斑块组（n = 21）和不稳定斑块组（n = 44）。不稳定斑块组患者再根据纤维帽的完整性分为未破裂斑块组（n = 29）和破裂斑块组（n = 15）。采用酶联免疫吸附测定法（ELISA）测定血清可溶性分化簇40配体（sCD40L）、基质金属蛋白酶9（MMP - 9）和妊娠相关血浆蛋白A（PAPP - A）水平。

结果

与稳定斑块组相比，不稳定斑块组、未破裂斑块组和破裂斑块组患者的血清sCD4OL和MMP - 9水平均显著升高（sCD40L：χ(2)=6.45、12.04和16.23，P < 0.01；MMP - 9：F = 2.55、5.10和4.69，P < 0.05）。与稳定斑块组相比，不稳定斑块组和破裂斑块组患者的血清PAPP - A水平均显著升高（χ(2)=11.71和13.55，P < 0.05）。与未破裂斑块组相比，破裂斑块组患者的血清PAPP - A水平显著升高（χ(2)=13.19，P = 0.000）。sCD40L≥673.22 ng/L（OR = 22.47，95%CI：2.11 - 239.81，P = 0.010）、MMP - 9≥84.09 μg/L（OR = 10.01，95%CI：1.74 - 57.78，P = 0.010）和PAPP - A≥0.101 μg/L（OR = 14.29，95%CI：2.69 - 75.90，P = 0.002）均与颈动脉斑块的易损性显著相关。