不同类型冠心病患者血清血小板源性生长因子表达及其与斑块超声显像特征的关系

摘要

目的 探讨不同类型冠心病患者血清血小板源性生长因子( PDGF)表达及其与斑块超声显像特征的相关性. 方法 选取冠状动脉(冠脉)造影检查患者138 例,其中急性冠脉综合征( ACS) 65 例[不稳定型心绞痛(UAP)组35例,急性心肌梗死(AMI)组30例],非急性冠脉综合征73例[稳定型心绞痛(SAP)组40例,陈旧性心肌梗死( OMI)组18例] ,冠脉造影正常者15例(对照组). 采用双抗体夹心酶联免疫吸附法检测各组血清PDGF水平,采用血管内超声检查ACS组和SAP组患者冠脉病变情况,比较不同性质斑块患者血清PDGF水平的差异.结果 SAP、OMI、UAP、AMI组血清PDGF浓度均高于对照组(P均<0.05);UAP、AMI组血清PDGF浓度高于SAP、OMI组(P均<0.05);AMI组血清PDGF浓度高于UAP组(P<0.05). SAP组冠脉病变以硬斑块为主,ACS组以软斑块为主;ACS组斑块破裂、血栓形成、正性重构发生率高于SAP组(P均<0.05),SAP组与ACS组偏心指数比较差异有统计学意义(P<0.05). 纤维斑块、钙化斑块、混合斑块患者血清PDGF浓度均低于软斑块患者(P均<0.05).结论 PDGF参与冠脉粥样硬化斑块的形成,血清PDGF水平检测可为临床诊断、预防和治疗ACS提供新的思路.%Objective To explore the expression of platelet-derived growth factor ( PDGF) in patients with different types of coronary heart disease and its correlation with the characteristics of ultrasound imaging of plaque.Methods We selected 138 cases of patients with coronary angiography, including 65 patients with acute coronary syndrome (ACS), 35 patients with unstable angina ( UAP) and 30 patients with acute myocardial infarction ( AMI) , 73 patients with non-acute coronary syndrome, including 40 patients with stable angina ( SAP) and 18 patients with old myocardial infarction ( OMI) , and 15 patients with normal coronary angiography.Using double antibody sandwich enzyme-linked immunosorbent method to detect serum level of PDGF in patients.Using intravascular ultrasound was used to detect the coronary lesions of patients with ACS and SAP, and we compared the differences in the levels of serum PDGF in different plaques of patients.Results The serum PDGF concentrations in the SAP, OMI, UAP and AMI patients were higher than those of the control group (all P<0.05), the serum PDGF concentrations of the UAP and AMI patients were higher than those of the SAP and OMI patients (all P<0.05);the serum PDGF concentration of AMI patients was higher than the UAP patients (P<0.05). The coronary lesions in the SAP group were mainly hard plaques, and those of the ACS group were mainly soft plaques.The occurrence rates of ACS plaque rupture, thrombosis and positive remodeling were higher than those of SAP (all P<0.05), and the difference between SAP and ACS was statistically significant (P<0.05).The average level of PDGF in patients with fibrous plaque, calcified plaque and mixed plaque was lower than that of patients with soft plaque (all P<0.05). Conclusions PDGF is involved in the formation of coronary atherosclerotic plaque, and serum PDGF level can provide a new way for clinical diagnosis, prevention and treatment of ACS.