Wang Xianjin, Chen Qun, Xu Yu, Wang Yanqing, Yang Yang, Gu Ming, Xu Haihua, Zhao Yanfang
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with Anhui Medical University, No. 34, Biao 34, Yanggongjing, Qinhuai District, Nanjing, Jiangsu, 210000, China.
Department of Cardiology, the Eighty-first Hospital of PLA Affiliated with the Nanjing University of Chinese Medicine, Nanjing, China.
Lipids Health Dis. 2017 Mar 23;16(1):63. doi: 10.1186/s12944-017-0456-z.
Few data exist that correlate lesion-related risk factors such as conventional cardiovascular risks or lipoprotein-associated phospholipase A2 (Lp-PLA2) with tissue types within atherosclerotic plaques in patients with single-vessel and intermediate coronary lesions.
One hundred and ninety-two patients with single-vessel and intermediate coronary lesions were enrolled in a cross-sectional study and divided into two groups: stable angina pectoris (SAP) and acute coronary syndrome (ACS) groups. Data regarding clinical characteristics and Lp-PLA2 mass were collected. Using iMAP-IVUS, lumen areas were manually traced to determine the minimum lumen area (MLA) at 1-mm intervals in diseased segments. At the minimum lumen lesion, areas of different types of atherosclerotic tissue [i.e., areas of fibrous plaque tissue (FP), fibro-fatty tissue (FF), dense calcium (DC) and necrotic core (NC)], vascular external elastic membrane (EEMCSA) and plaque and media (P&MCSA) were calculated using the built-in iMap algorithm. Plaque burden was computed as P&MCSA divided by EEMCSA.
In a univariate analysis, glycosylated hemoglobin A1C (GHbA1C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hypertension, Lp-PLA2 and a history of taking statins predicted the degree of FP and NC area, as well as plaque burden, but were not significant predictors of FF or DC area. In a multivariate analysis, Lp-PLA2 and HbA1c remained independent predictors of plaque burden, FP and NC area. However, the results of the regression analyses were not identical when the SAP and ACS groups were analyzed separately. Lp-PLA2, diabetes and NC area were significant predictors of acute coronary lesions, and the predictive value of Lp-PLA2 was confirmed by the finding of a high area-under-the-curve in a ROC analysis (0.837, 95% CI:0.778-0.895, P = 0.000), as well as by the reasonable sensitivity and specificity of cut-off values.
GHbA1C and Lp-PLA2 were strong independent predictors of plaque burden and FP and NC area at the minimum lumen lesion in patients with single-vessel and intermediate coronary lesions. Furthermore, Lp-PLA2 has a certain predictive value for acute coronary lesions.
在单支冠状动脉中度病变患者中，关于病变相关危险因素（如传统心血管危险因素或脂蛋白相关磷脂酶A2（Lp-PLA2））与动脉粥样硬化斑块内组织类型之间相关性的数据较少。
192名单支冠状动脉中度病变患者纳入一项横断面研究，并分为两组：稳定型心绞痛（SAP）组和急性冠状动脉综合征（ACS）组。收集临床特征和Lp-PLA2质量的数据。使用iMAP-IVUS，手动描绘管腔面积以确定病变节段中每1毫米间隔处的最小管腔面积（MLA）。在最小管腔病变处，使用内置iMap算法计算不同类型动脉粥样硬化组织的面积[即纤维斑块组织（FP）、纤维脂肪组织（FF）、致密钙（DC）和坏死核心（NC）的面积]、血管外弹性膜（EEMCSA）以及斑块和中膜（P&MCSA）。斑块负荷计算为P&MCSA除以EEMCSA。
在单因素分析中，糖化血红蛋白A1C（GHbA1C）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、高血压、Lp-PLA2以及服用他汀类药物的病史可预测FP和NC面积程度以及斑块负荷，但不是FF或DC面积的显著预测因素。在多因素分析中，Lp-PLA2和糖化血红蛋白仍为斑块负荷、FP和NC面积的独立预测因素。然而，当分别分析SAP组和ACS组时，回归分析结果并不相同。Lp-PLA2、糖尿病和NC面积是急性冠状动脉病变的显著预测因素，并且Lp-PLA2的预测价值通过ROC分析中较高的曲线下面积（0.837，95%CI：0.778 - 0.895，P = 0.000）以及截断值合理的敏感性和特异性得到证实。
在单支冠状动脉中度病变患者中，GHbA1C和Lp-PLA2是最小管腔病变处斑块负荷以及FP和NC面积的强有力独立预测因素。此外，Lp-PLA2对急性冠状动脉病变具有一定的预测价值。
