冠脉斑块CT值改变及血清炎性因子与冠脉斑块稳定性的相关研究

目的应用128层螺旋CT冠状动脉成像技术(128-SCTA)检测冠状动脉斑块CT值,联合炎症因子高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)及基质金属蛋白酶9(MMP-9)评价冠脉斑块的易损性.方法选择100名冠心病患者为研究对象,50例为不稳定型心绞痛(UAP)组,50例为稳定型心绞痛(SAP)组,行冠脉CTA检查,并根据CT值的不同,将这些患者的冠脉斑块分为易损斑块(CT值60 Hu)、混合斑块(CT值60-129 Hu)和硬斑块(CT值130 Hu).所有患者均采集血样,进行炎症因子hs-CRP,IL-6及MMP-9检测.结果 1)血清hsCRP,IL-6及MMP-9水平在UAP组明显高于SAP组(P0.01).2)UAP组易损斑块占总斑块数的52.9%,硬斑块组占总斑块数的17.6%,前者显著高于后者(P0.01);SAP组易损斑块占总斑块数的19.4%,硬斑块数占总斑块数的51.6%,后者显著高于前者(P0.01);易损斑块在UAP组的分布显著高于SAP组(P0.001).3)hs-CRP,IL-6及MMP-9与斑块CT值呈负性相关(P0.01).结论 128-SCTA可用于评估冠脉斑块的形态学特点,为冠心病患者早期发现易损斑块提供一种安全、简单、无创的方法.

On CT Value Changes of Coronary Plaque and Serum Inflammatory Factors and Stability of Coronary plaque

Objective The study was to detect CT value of coronary artery plaque by applying 128-slice spiral computed tomography coronary angiography ( 128-SCTA ) and examing inflammatory cytokine including high-sensitivity C-reactive protein ( Hs-CRP ) , interleukin-6 ( IL-6 ) and matrix metalloproteinases-9 ( MMP-9 ) in order to evaluate the vulnerability of coronary artery plaque. Method One hundred patients with coronary heart disease were divided into unstable angina pectoris ( UAP ) group and stable angina pectoris ( SAP ) group. The patients were examined by 128-slice spiral computed tomography coronary angiography. According to CT value, coronary artery plaques were divided into vulnerable plaque ( CT value<60 Hu ) , mix plaqu ( CT value 60-129 Hu) ,and hard plaque ( CT value>130 Hu) . The blood specimen were colleted from all the patients. The levels of hs-CRP,IL-6 and MMP-9 were examined. Results 1) The levels of hs-CRP,IL-6 and MMP-9 of UAP group were significantly higher than those of SAP group ( P<0 . 01 ) . 2 ) According to the results of all kinds of plague distribution,the vulnerable plaque accounted for 52. 9% in UAP group and hard plaque accounts for 17. 6%,that showing that the former was significantly higher than the latter. Vulnerable plaque accounts for 19. 4% in SAP group,hard plaque group accounts for 51. 6%, that showing that the latter was significantly higher than the former. Vulnerable plaque in UAP group was significantly higher than that of SAP group(P<0. 001). 3)The linear correlation between CT value and inflammatory factors showed that:hs-CRP , IL-6 and MMP-9 were negatively related with plaque CT value ( P<0 . 01 ) . Conclusion 128-SCTA may be employed to assess the morphology of coronary artery plaque to determine vulnerable plaque, mix plaque and hard plaque. 128-SCTA combining hs-CRP,IL-6 and MMP-9 make the inspection of vulnerable plaques coronary more accurately,which supply a safer,simpler and non-invasive method for CHD patients to find earlier vulnerable plaques.