急性冠脉综合征血管内超声斑块显像与血清淀粉样蛋白A、妊娠相关蛋白A表达的相关性研究

摘要

目的:探讨急性冠脉综合征(ACS)患者血管内超声(IVUS)显像与血清淀粉样蛋白A(SAA)、妊娠相关血浆蛋白A(PAPP-A)浓度的相关性.方法:按照1979年WHO缺血性心脏病诊断标准选择80例住院冠心病患者,分为稳定型心绞痛(SAP)组(20例)和ACS组(60例),所有患者均行IVUS、冠脉造影检查,术前至少1h分别检测患者血清SAA、血浆PAPP-A的浓度,并与IVUS检查所得出的斑块纤维帽厚度、偏心指数、重构指数比较,分析其相关性.结果:与SAP组患者相比,ACS组患者纤维帽厚度明显变薄[(1.0±0.2)mm∶(0.7±0.1)mm],偏心指数[(0.4±0.1)∶(0.9±0.2)]、重构指数明显提高[(0.8±0.1)∶(1.3±0.2)],SAA[(13.75±9.65)MIU/L∶(36.4±12.32)MIU/L]、PAPP-A[(10.36±8.25)mg/L∶(32.68±12.5)mg/L]浓度明显升高(P均＜0.001).SAA、PAPP-A水平与纤维帽厚度均呈负相关(r=-0.68,-0.68,P均＜0.05),与偏心指数(r=0.75,0.81)、重构指数(r=0.71,0.78)呈正相关(P均＜0.05).结论:急性冠脉综合征患者易损斑块的纤维帽厚度、偏心指数、重构指数(斑块稳定性)与血清淀粉样蛋白A、妊娠相关蛋白A存在相关关系,血清淀粉样蛋白A、妊娠相关蛋白A可作为预测易损斑块稳定性的重要指标.%Objective: To explore the correlation between plaque image characteristics detected by intravascular ultrasound (IVUS) in patients with acute coronary syndrome (ACS) and levels of serum amyloid protein A (SAA) and pregnancy-associated plasma protein A (PAPP-A). Methods: According to WHO diagnostic standard of ischemic heart diseases (IHD)in 1979, a total of 80 IHD inpatients were enrolled and divided into stable angina pectoris (SAP) group (n=20) and ACS group (n=60). All patients underwent coronary angiograph (CAG) and IVUS, and concentrations of SAA and PAPP-A were measured at 1h before CAG. Their correlation with fibrous cap thickness of plaque, eccentricity index (EI) and remodeling index (RI) measured by IVUS were analyzed . Results: Compared with SAP group, fibrous cap thickness of plaque [(1. 0±0. 2)mm vs. (0. 7±0. 1)mm] significantly decreased, EI[0. 4±0. 1) vs. (0. 9±0. 2)] and RI [(0. 8±0. 1) vs. (1. 3±0. 2)] significantly increased, concentrations of SAA [(13. 75±9. 65) MIU/L vs. (36. 4±12. 32) MIU/L] and PAPP-A [(10. 36±8. 25)mg/L vs. (32. 68±12. 5) mg/L] significantly increased in ACS group (P＜0. 001 all). Levels of SAA and PAPP-A were negatively correlated with fibrous cap thickness (r=-0. 68,-0. 68,P＜0. 05 all), and positively correlated with EI (r=0. 75,0. 81) and RI (r=0. 71, 0. 78) ,P＜0. 05 all. Conclusion: There is a relationship among serum levels of SAA and PAPP-A and fibrous cap thickness, eccentricity index and remodeling index (stability of vulnerable plaque) in patients with ACS, so values of SAA and PAPP-A may be valuable to predict the stability of vulnerable plaque.