Zhong Y, Ye F, You W, Wu Z M
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Jul 24;45(7):566-571. doi: 10.3760/cma.j.issn.0253-3758.2017.07.004.
To identify the correlation between serum inflammatory cytokine levels including high sensitive C reactive protein (hs-CRP) and lipoprotein associated phospholipase (Lp-PLA2) and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions. Clinical data of 117 patients with selective coronary artery angiography diagnosed coronary artery disease admitted to our hospital from January 2015 to January 2016 were retrospective analyzed. According to type of coronary disease, patients were divided into 3 subgroups: SAP group (containing 47 stable angina patients), UAP group (containing 52 unstable angina patients), and NSTEMI group(containing 18 acute non ST segment elevation myocardial infarction patients). Serum hs-CRP and Lp-PLA2 levels were measured before subsequent procedures. The characteristics of the culprit lesions were detected by optical coherence tomogarpgy(OCT) before interventional treatment, and the correlation between hs-CRP and Lp-PLA2 and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were analyzed. (1) The serum levels of hs-CRP (2.13(1.04, 4.75)μg/L vs. 1.02(0.60, 1.29)μg/L and 1.30(1.03, 1.96)μg/L, all <0.05) and Lp-PLA2 ((394.8±61.4)mg/L vs. (140.1±40.4)mg/L and (284.5±93.6)mg/L, all <0.05) were significantly higher in NSTEMI group than in SAP group and UAP group, and serum levels of hs-CRP and Lp-PLA2 were significantly higher in UAP group than in SAP group (all <0.05). (2)The fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were smaller in NSTEMI group and UAP group than in SAP group(50(50, 60)μm and 60(50, 90)μm vs. 130(80, 190)μm, all <0.05), and there was no significantly difference between NSTEMI group and UAP group(>0.05). Proportion of thin-cap fibroatheroma plaque(82.35%(14/18) vs. 19.15%(9/47) and 63.46%(33/52), all <0.05), plaque rupture(55.56%(10/18)vs. 6.38%(3/47) and 28.85%(15/52), all <0.05) and thrombosis(33.33%(6/18) vs. 4.26%(2/47) and 9.26%(5/52), all <0.05) were significantly higher in NSTEMI group than in SAP group and UAP group. Proportion of calcifiacation in plaque was lower in NSTEMI group than in SAP group (11.11%(2/18)vs. 42.55%(20/47), <0.05), and there was no significantly difference between NSTEMI group and UAP group(>0.05). (3) Pearson correlation analysis showed that serum levels of hs-CRP(=-0.233, <0.05) and Lp-PLA2(=-0.465, <0.01)were negatively correlated with fibrous cap thickness of fibrofatty plaques. Spearman correlation analysis showed that serum levels of hs-CRP were positively correlated with plaque rupture(=0.409, <0.01) and thrombosis (=0.227, <0.05), and serum levels of Lp-PLA2 were also positively correlated with plaque rupture(=0.499, <0.01) and thrombosis(=0.263, <0.01). (4)Multiple logistic regression analysis showed that serum levels of Lp-PLA2 at baseline was independently related to thin-cap fibroatheroma plaque(=1.017, <0.01). The serum levels of hs-CRP and Lp-PLA2 in NSTEMI patients are much higher than that in SAP and UAP patients, higher in UAP patients than in SAP patients. Prevalence of thin-cap fibroatheroma plaque, plaque rupture and thrombosis was significantly higher in the NSTEMI patients, while the prevalence of calcification in plaque is more often in SAP patients. Increased serum levels of Lp-PLA2 are independent risk factor of thin-cap fibroatheroma plaque formation.
旨在确定包括高敏C反应蛋白（hs-CRP）和脂蛋白相关磷脂酶A2（Lp-PLA2）在内的血清炎症细胞因子水平与冠状动脉罪犯病变中纤维脂肪斑块纤维帽厚度之间的相关性。对2015年1月至2016年1月我院收治的117例经选择性冠状动脉造影确诊为冠心病的患者的临床资料进行回顾性分析。根据冠心病类型，将患者分为3个亚组：稳定性心绞痛（SAP）组（47例稳定性心绞痛患者）、不稳定性心绞痛（UAP）组（52例不稳定性心绞痛患者）和非ST段抬高型心肌梗死（NSTEMI）组（18例急性非ST段抬高型心肌梗死患者）。在后续操作前检测血清hs-CRP和Lp-PLA2水平。在介入治疗前通过光学相干断层扫描（OCT）检测罪犯病变的特征，并分析hs-CRP、Lp-PLA2与冠状动脉罪犯病变中纤维脂肪斑块纤维帽厚度之间的相关性。（1）NSTEMI组血清hs-CRP水平（2.13（1.04，4.75）μg/L vs. 1.02（0.60，1.29）μg/L和1.30（1.03，1.96）μg/L，均<0.05）及Lp-PLA2水平（（394.8±61.4）mg/L vs.（140.1±40.4）mg/L和（284.5±93.6）mg/L，均<0.05）显著高于SAP组和UAP组，且UAP组血清hs-CRP和Lp-PLA2水平显著高于SAP组（均<0.05）。（2）NSTEMI组和UAP组冠状动脉罪犯病变中纤维脂肪斑块的纤维帽厚度小于SAP组（50（50，60）μm和60（50，90）μm vs. 130（80，190）μm，均<0.05），NSTEMI组与UAP组之间无显著差异（>0.05）。NSTEMI组薄帽纤维粥样斑块比例（82.35%（14/18）vs. 19.15%（9/47）和63.46%（33/52），均<0.05）、斑块破裂比例（55.56%（10/18）vs. 6.38%（3/47）和28.85%（15/52），均<0.05）及血栓形成比例（33.33%（6/18）vs. 4.26%（2/47）和9.26%（5/52），均<0.05）显著高于SAP组和UAP组。NSTEMI组斑块钙化比例低于SAP组（11.11%（2/18）vs. 42.55%（20/47），<0.05），NSTEMI组与UAP组之间无显著差异（>0.05）。（3）Pearson相关分析显示，血清hs-CRP水平（r=-0.233，<0.05）和Lp-PLA2水平（r=-0.465，<0.01）与纤维脂肪斑块纤维帽厚度呈负相关。Spearman相关分析显示，血清hs-CRP水平与斑块破裂（r=0.409，<0.01）和血栓形成（r=0.227，<0.05）呈正相关，血清Lp-PLA2水平与斑块破裂（r=0.499，<0.01）和血栓形成（r=0.263，<0.01）也呈正相关。（4）多因素logistic回归分析显示，基线时血清Lp-PLA2水平与薄帽纤维粥样斑块独立相关（r=1.017，<0.01）。NSTEMI患者血清hs-CRP和Lp-PLA2水平远高于SAP和UAP患者，UAP患者高于SAP患者。NSTEMI患者薄帽纤维粥样斑块、斑块破裂和血栓形成的发生率显著更高，而SAP患者斑块钙化的发生率更高。血清Lp-PLA2水平升高是薄帽纤维粥样斑块形成的独立危险因素。
