Objective To investigate the correlation among the characteristics of plaques, the plasma level of homocysteine and gene polymorphism of homocysteine ( Hcy) metabolism-related enzyme in acute coronary syndrome (ACS). Methods According to consecutive , the plasma level of Hcy was measured by flourescence-biochemistry method, gene polymorphism of Hcy metabolism-related enzyme methylenetetrahydrofolate reductase (MTHFR) C677T was examined by Taqman probe technology. Disease lesions were examined by intravascular ultrasound (IVUS). Culprit lesions about the characteristics of the plaque were studied, the external elastic membrane cross-sectional area (EEMA) and lumen cross-sectional area (LA) were measured, the plaque area, plaque burden, eccentricity index (EI) were calculated, and the remodeling index was examined. Results Hard plaques were dominant in stable angina pectoris ( SPA) group, soft plaques were dominant in ACS group (P < 0. 001). The probability of rupturing plaque and thrombus was higher in ACS group ( P < 0. 05). Compared with SPA group, the plaque burden was heavier in ACS group (P < 0. 05), the eccentricity index was significantly larger in SPA group than that of ACS group (P <0.001) . Positive remodeling was more frequent in ACS group, whereas negative remodeling was more frequent in SPA group (P< 0.001). Compared with the stable plaque group, plasma Hcy level was higher in unstable plaque group (P< 0. 001). The constituent ratio of MTHFR C677T genotype were different in stable plaque group and vulnerable plaque group ( P < 0. 05 ). With T genotype could increase the incidence rate of vulnerable plaque. Conclusions Higher Hcy and MTHFR C677T gene polymorphism are the risk factors for vulnerable plaque. They could be considered as the index which can predict the unstability of the atherosclerotic plaque.%目的 探讨急性冠脉综合征不稳定斑块与血浆同型半胱氨酸(Hey)及亚甲基四氢叶酸还原酶(MTHFR) C677基因多态性的相关性.方法 采用连续病例对照研究,荧光生化法检测血浆Hey水平,血管内超声对病变部位进行定性定量研究,应用Taqman探针技术进行MTHFRC677T基因多态性分析.结果 稳定型心绞痛(SPA)组患者冠脉病变处以硬斑块为主,急性冠脉综合征(ACS)组患者冠脉病变处以软斑块为主(P＜0.001)；ACS组患者斑块破裂及血栓形成发生率较SPA组高(P＜0.05)；ACS组病变处斑块负荷重(P＜0.05),ACS组病变处以偏心斑块为主(P＜0.05),以正性重构多见(P＜0.001).ACS组与SPA组,高Hcy比率差异显著(P＜0.001).ACS与SPA之间MTHFR C677T基因型构成比差异显著；携带T基因明显增加斑块不稳定的风险.结论 高Hcy和MTHFR C677T基因多态性是ACS斑块不稳定的危险因素,可以作为预测斑块不稳定的指标.
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