Objective: To evaluate the correlative risk factor of culprit lesion plaque composition in patients with acute coronary syndrome (ACS). Methods: A total of 55 ACS patients with 55 culprit vessels were divided into 2 groups:Unstable angina group, n=40 and AMI group, n=15. Coronary angiography (CAG) was conducted in all patients, the minimal lumen area and plaque burden at the minimal lumen area and the largest necrotic core were examined. Intravascular ultrasound with virtual histology (IVUS-VH) were performed to calculate the percentages of necrotic core area (NC%), dense calcium (DC%), ifbro-fatty area (FF%), ifbrous area (FI%) and to calculate the remodeling index. Plasma levels of matrix metalloproteinase-9 (MMP-9), oxidative low density lipoprotein (Ox-LDL) and hypersensitive c-reactive protein (hs-CRP) were also compared between 2 groups. Results: In AMI group and UAP group, NC%at minimal lumen area were (27.90 ± 9.72)%and (19.41 ± 11.53)%, t=-2.533, P=0.014;NC%at the largest necrotic core were (39.09 ± 8.82)%and (31.99 ±1 2.35)%, t=-2.032, P=0.047;plasma levels of MMP-9 were (14.63±2.71) µg/L and (12.65±2.72) µg/L, t=-2.411, P=0.019;Ox-LDL were (196.21±25.89) µg/L and (159.57±33.39) µg/L, t=-3.832, P=0.001;hs-CRP were (1.57±1.93) mg/L and (0.31±0.33) mg/L, t=-2.514, P=0.024 respectively. Plaque composition was not related to plasma levels of MMP-9, Ox-LDL and hs-CRP. In the largest necrotic core of cruprit lesion and the minimal lumen area, MLA were (5.25±2.15) mm2 and (3.45±1.07) mm2, t=-6.348, P=0.001;NC%were (33.93±11.85)%and (21.73±11.62)%, t=-8.752, P=0.001 respectively. Conclusion: ①Among ACS patients, AMI patients had the larger necrotic core area at cruprit lesion and higher MMP-9, Ox-LDL and hs-CRP.②There was no largest necrotic core composition at the minimal lumen area in the same cruprit lesion.③Plaque composition was not related to MMP-9, Ox-LDL and hs-CRP.%目的：评价急性冠状动脉综合征（ACS）患者梗死相关血管病变（罪犯病变）斑块组织成分的相关危险因素。 方法：对55例ACS患者行冠状动脉造影（55支罪犯血管）同时进行血管内超声虚拟组织成像（IVUS-VH）检查，根据诊断不同分为不稳定性心绞痛组（UAP组）40例，急性心肌梗死组（AMI组）15例。分析最小管腔面积处和病变最大坏死核处的最小管腔面积、斑块负荷，IVUS-VH分析坏死核面积百分比（NC%）、致密钙化面积百分比（DC%）、纤维脂肪组织面积百分比（FF%）、纤维组织面积百分比（FI%），计算重构指数。酶联免疫吸附（ELISA）法检测血清金属基质蛋白酶-9（MMP-9）、氧化低密度脂蛋白（ox-LDL）和超敏C反应蛋白（ hs-CRP）水平。 结果：AMI组和UAP组最小管腔面积处的NC%分别为（27.90±9.72）%和（19.41±11.53）%（t=-2.533， P=0.014）；最大坏死核处的NC%分别为（39.09±8.82）%和（31.99±12.35）%（t=-2.032，P=0.047）；两组比较差异均有统计学意义。AMI组和UAP组的MMP-9水平分别为（14.63±2.71）µg/L和（12.65±2.72）µg/L（t=-2.411， P=0.019）；ox-LDL水平分别为（196.21±25.89）µg/L和（159.57±33.39）µg/L（t=-3.832，P=0.001）；hs-CRP水平分别为（1.57±1.93）mg/L和（0.31±0.33）mg/L（t=-2.514，P=0.024）；两组比较差异均有统计学意义。斑块组织成分与MMP-9、ox-LDL、hs-CRP水平不相关。罪犯病变最大坏死核处和最小管腔面积处的最小管腔面积分别为（5.25±2.15） mm2和（3.45±1.07）mm2（t=-6.348，P=0.001）；NC%分别为（33.93±11.85）%和（21.73±11.62）%（t=-8.752， P=0.001），两者比较差异均有统计学意义。 结论：（1）在ACS患者中，AMI患者较UAP患者的罪犯病变坏死核组织成分面积大，血清MMP-9、ox-LDL和hs-CRP水平高。（2）在同一罪犯病变中最小管腔面积处并不具有最大坏死核组织。（3）血清MMP-9、ox-LDL和hs-CRP水平与斑块组织成分无关。
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