摘要：
目的 探讨冠状动脉粥样硬化患者血小板衍化生长因子(PDGF)血清水平表达和临床监控意义.方法 选择进行冠脉造影及血管内超声(IVUS)检查的190例患者作为研究对象,按照冠脉造影及IVUS检查结果分为稳定斑块组(56例)、易损斑块组(44例)、混合斑块组(50例)及冠脉造影未见异常组(40例).使用RT-PCR法检测血清PDGF-mRNA表达水平,同时对患者总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(UA)、尿素氮(BUN)、载脂蛋白A(apoaA)、载脂蛋白B(apoaB)进行检测,并根据每一患者动脉造影检查结果,使用Gensini积分系统对每一支冠脉血管进行定量评价,分析PDGF-mRNA表达水平与上述因素的相关性.结果 ①各组患者PDGF-mRNA表达水平存在显著性差异,且易损斑块组水平＞混合斑块组＞稳定斑块组＞未见异常组(P均＜0.05).②TC、TG、UA水平比较,易损斑块组最高,其他依次为混合斑块组、稳定斑块组、未见异常组,差别具有统计学意义(P＜0.05).出现血管狭窄的三组患者,易损斑块组Gensini得分最高,混合斑块组次之,稳定斑块组最低(P＜0.05).③Pearson双变量相关分析显示,PDGF-mRNA表达水平与Gensini得分(r=0.34,P=0.003)、BMI (r=0.15,P=0.032)、TG(r =0.21,P=0.011)、TC(r =0.17,P=0.015)呈正相关,与HDL-C呈负相关(r=-0.25,P=0.013),与年龄(r=0.05,P＞0.05)、性别(r=0.09,P＞0.05)、BUN(r =0.07,P＞0.05)、UA(r =0.03,P＞0.05)、apoaA(r=0.06,P＞0.05)及apoaB(r=0.10,P＞0.05)不相关.④Logistic回归分析结果显示,Gensini得分(β=0.31)、BMI(β=0.23)、TG (β =0.13)、TC (β=0.10)越高,PDGF-mRNA值越大,而HDL-C表达水平(β=-0.17)对PDGF-mRNA形成负向调节(P＜0.05).结论 血小板衍化生长因子是冠状动脉粥样硬化的独立影响因子,其表达水平与冠脉病变严重程度密切相关.密切监测患者PDGF-mRNA表达水平,可实现对患者冠脉病变的客观评估.%Objective To explore the expression of platelet derived growth factor(PDGF) in patients with coronary atherosclerosis and its clinical monitoring significance.Methods 190 patients with coronary angiography and IVUS examination were selected as study subjects,they were divided into stable plaque group(56 cases),vulnerable plaque group (44 cases),mixed plaque group(50 cases) and coronary angiography no abnormal group (40cases) according to coronary angiography and IVUS examination results.The expression level of serum PDGF-mR-NA was detected by RT-PCR method,the total cholesterol (TC),triglyceride (TG),high density lipoprotein (HDL-C),low density lipoprotein(LDL-C),blood uric acid (UA),blood urea nitrogen (BUN),carrying lipoprotein A (apoaA),set the apolipoprotein B (apoaB) were detected at the same time.The Gensini integral system was used for quantitative evaluation of each coronary artery according to the results of each patient's arterial angiography.The correlation between PDGF-mRNA expression level and the above factors was analyzed.Results (1)There were significant differences in the level of PDGF-mRNA expression in each group,and the value of the Vulnerable plaque group ＞ the mixed plaque group ＞ the stable plaque group ＞ the no abnormal group(P＜0.05).(2)The TC,TG,UA levels were compared among the groups,in which the values of vulnerable plaque group was the highest,the other was mixed plaque group,stable plaque group,no abnormal group,the difference was statistically significant.The Gensini score of the vulnerable plaque group was highest,and followed by the mixed plaque group,the value of stable plaque group was lowest (P＜0.05).(3)Pearson bivariate correlation analysis showed that:PDGF-mRNA expression levels were positively correlated with Gensini score(r=0.34,P=0.003),BMI (r=0.15,P=0.032),TG (r=0.21,P=0.011),TC (r=0.17,P=0.015);PDGF-mRNA expression levels were negatively correlated with HDL-C (r=-0.25,P=0.013),and were not related with age(r=0.05,P＞0.05),gender(r=0.09,P＞0.05),BUN (r=0.07,P＞0.05),UA (r=0.03,P＞0.05),apoaA (r=0.06,P＞0.05) and apoaB (r=0.10,P＞0.05).(4)Logistic regression analysis showed that the higher of Gensini score (β=0.31),BMI(β=0.23),TG(β=0.13),TC (β=0.10),the greater of PDGF-mRNA value.The expression level of HDL-C (β=-0.17) was negatively correlated with the level of PDGF-mRNA.Conclusion Platelet-derived growth factor (PDGF) was the independent risk factor of coronary atherosclerosis,whose expression level was closely related to the severity of coronary artery disease.Close monitoring of patients with PDGF-mRNA expression levels can objectively assess the extent of coronary lesions.
