Department of Cardiology, Aviation General Hospital, Beijing 100016, China.
Department of Cardiology, Beijing Daxing Hospital, Capital Medical University, Beijing 102600, China.
Chin Med J (Engl). 2018 Jun 20;131(12):1444-1449. doi: 10.4103/0366-6999.233953.
Acute coronary syndrome (ACS) is closely related to unstable plaques and secondary thrombosis. The inflammatory cells in plaques and their inflammatory products may be the cause for plaque instability and ruptures. The study aimed to disclose the changes of inflammatory factors including serum intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40), and lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with ACS and its clinical significance.
A total of 120 patients with coronary heart disease (CHD) were categorized into 2 groups: 69 with ACS and 51 with stable angina pectoris (SAP); 20 patients with chest pain and normal angiography served as a control group. The 120 patients with CHD were categorized into single-vessel disease group, double-vessel disease group, and three-vessel disease group based on the number of coronary artery stenosis. The severity of coronary artery stenosis was quantified based on coronary angiography using Gensini score. They were further divided into mild CHD group with its Gensini score <26 (n = 36), moderate CHD group with its Gensini score being 26-54 (n = 48) and severe CHD group with its Gensini score >54 (n = 36). Serum levels of ICAM-1, YKL-40, and Lp-PLA2 of different groups were determined by enzyme-linked immunosorbent assay. Correlation between ICAM-1, YKL-40, Lp-PLA2, and Gensini score was analyzed.
The levels of serum inflammatory factors ICAM-1, YKL-40, and Lp-PLA2 were significantly higher in the ACS group than those in control group and SAP group (all P < 0.05); and compared with control group, no significant difference was observed in terms of the serum ICAM-1, YKL-40, and Lp-PLA2 levels in the SAP group (P > 0.05).The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, single-vessel disease group, double-vessel disease group, and three-vessel disease group (all P > 0.05). The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, mild CHD group (Gensini score <26), moderate CHD group (Gensini score 26-54), and severe CHD group (Gensini score >54) (all P > 0.05). Nonparametric Spearman correlation analysis showed that the levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not correlated with the Gensini score in CHD patients (r = 0.093, r = -0.149, and r = -0.085, all P > 0.05; respectively).
The serum levels of ICAM-1, YKL-40, and Lp-PLA2 were correlated with different clinical types of CHD, but not well correlated the severity and extent of artery stenosis, suggesting that ICAM-1, YKL-40, and Lp-PLA2 might be involved in occurrence of instability of atherosclerotic plaque, and might reflect the severity of CHD mostly through reflecting the plaque stability.
急性冠状动脉综合征（ACS）与不稳定斑块和继发性血栓形成密切相关。斑块中的炎症细胞及其炎症产物可能是斑块不稳定和破裂的原因。本研究旨在揭示 ACS 患者炎症因子（包括血清细胞间黏附分子-1（ICAM-1）、壳聚糖酶-3 样蛋白 1（YKL-40）和脂蛋白相关磷脂酶 A2（Lp-PLA2））的变化及其临床意义。
将 120 例冠心病（CHD）患者分为 2 组：ACS 组 69 例，稳定性心绞痛（SAP）组 51 例；20 例胸痛且冠状动脉造影正常的患者作为对照组。根据冠状动脉狭窄数量，120 例 CHD 患者分为单支血管病变组、双支血管病变组和三支血管病变组。采用 Gensini 评分根据冠状动脉造影定量评估冠状动脉狭窄严重程度。根据 Gensini 评分<26 分为轻度 CHD 组（n=36）、26-54 分为中度 CHD 组（n=48）和>54 分为重度 CHD 组（n=36）。采用酶联免疫吸附法检测各组患者血清中 ICAM-1、YKL-40 和 Lp-PLA2 水平。分析 ICAM-1、YKL-40、Lp-PLA2 与 Gensini 评分的相关性。
ACS 组患者血清炎症因子 ICAM-1、YKL-40 和 Lp-PLA2 水平明显高于对照组和 SAP 组（均 P<0.05）；与对照组相比，SAP 组患者血清 ICAM-1、YKL-40 和 Lp-PLA2 水平差异无统计学意义（P>0.05）。对照组、单支血管病变组、双支血管病变组和三支血管病变组患者血清 ICAM-1、YKL-40 和 Lp-PLA2 水平差异无统计学意义（均 P>0.05）。对照组、轻度 CHD 组（Gensini 评分<26）、中度 CHD 组（Gensini 评分 26-54）和重度 CHD 组（Gensini 评分>54）患者血清 ICAM-1、YKL-40 和 Lp-PLA2 水平差异无统计学意义（均 P>0.05）。非参数 Spearman 相关分析显示，CHD 患者血清 ICAM-1、YKL-40 和 Lp-PLA2 水平与 Gensini 评分无相关性（r=0.093、r=-0.149 和 r=-0.085，均 P>0.05）。
血清 ICAM-1、YKL-40 和 Lp-PLA2 水平与 CHD 不同临床类型相关，但与动脉狭窄程度和范围无明显相关性，提示 ICAM-1、YKL-40 和 Lp-PLA2 可能参与动脉粥样硬化斑块的不稳定，主要通过反映斑块的稳定性来反映 CHD 的严重程度。
