颈动脉粥样硬化斑块与血浆髓过氧化物酶预测冠状动脉狭窄程度

摘要

Objective To assess the predictive value of plasma myeloperoxidase (MPO) concentration combined with carotid intima-media thickness (IMT) and Crouse score for the severity of coronary artery stenosis in patients with coronary heart disease (CHD). Methods Totally 131 patients with suspected acute coronary syndrome were enrolled. The plasma MPO concentration was measured at the second day of hospitalization, and coronary artery angiography (CAG) and the carotid ultrasound examination was performed in the following week. Each participant was assigned to CHD group or the control group according to the results of CAG. The value of IMT, Crouse score, plasma MPO concentration and the combination of three parameters in predicting coronary heart disease was evaluated by ROC analysis. Results Compared with control group, plasma MPO concentration, carotid IMT and Crouse score significantly increased in CHD group (all P<0. 01). IMT score, Crouse score and plasma MPO concentration were positively correlated with the severity of coronary stenosis. ROC analysis revealed that the area under the curves of IMT score, Crouse score, plasma MPO concentration and the combination of the three parameters in predicting the coronary stenosis severity was 0. 657, 0. 792, 0. 785 and 0. 814, respectively, indicating that the predictive value of the combination of the three parameters was markedly better than that of each single one. Conclusion The combination of carotid IMT score and Crouse score obtained by color Doppler ultrasound and plasma MPO concentration is a valuable assistant for predicting the severity of coronary stenosis in CHD patients.%目的 探讨以颈动脉内-中膜厚度(IMT)、粥样斑块Crouse积分联合血浆髓过氧化物酶(MPO)浓度预测冠状动脉粥样硬化性心脏病患者冠状动脉狭窄程度的价值.方法 收集131例疑似急性冠脉综合征患者,均于入院第2天接受血浆MPO浓度检测,入院1周内接受冠状动脉造影(CAG)及颈动脉超声检查.根据CAG结果将其分为冠心病组和对照组,计算颈动脉斑块的IMT积分及粥样斑块Crouse积分,应用ROC分析分别比较颈动脉IMT积分、粥样斑块Crouse积分、血浆MPO浓度及三者联合检测冠心病的价值.结果 冠心病组血浆MPO浓度、颈动脉IMT和粥样斑块Crouse积分均明显高于对照组(P均＜0.01),IMT积分、Crouse积分及血浆MPO浓度均与冠状动脉狭窄程度呈正相关.IMT积分、Crouse积分、MPO及三者联合检测冠心病的ROC曲线下面积分别为0.657、0.792、0.785及0.814,提示三者联合预测冠状动脉狭窄程度明显优于单个指标.结论 联合应用彩色多普勒超声检测颈动脉IMT及粥样斑块Crouse积分与血浆MPO浓度检测可作为评估冠状动脉粥样硬化性心脏病患者血管狭窄程度的有效辅助方法.