新蝶呤与社区人群颈动脉粥样硬化斑块稳定性的关系探讨

目的 探讨巨噬细胞活性标志物新蝶呤水平与超声评价的颈动脉粥样硬化斑块稳定性间的关系。方法 对142名广州社区居民进行颈动脉超声检查。根据斑块声像性质将研究对象分为无斑块组、高回声组和低回声组。其中低回声斑块定义为易损斑块。酶联免疫吸附试验测定清新蝶呤浓度。按浓度三分之一间距将研究对象分成低中高三个浓度组。结果 低回声斑块组血清新蝶呤水平（5.85.3-6.7]nmol/L）明显高于高回声斑块组（4.73.9-5.3]nmol/L）（P<0.01）及无斑块组（4.63.6-5.4]nmol/L）（P<0.01），但高回声斑块组和无斑块组没有明显差异(P=0.99)。高浓度组出现低回声斑块的比例（59.6%）明显高于低浓度组（12.5%, P<0.01)和中浓度组（29.8%, P＜0.05)，而中浓度组和低浓度组差异无统计学意义（P=0.12）。多因素校正后，新蝶呤仍然是预测易损斑块的独立因素，每升高1.0nmol/L(约四分之一间距)，危险比OR值为2.60(95%CI:1.70-3.96,P＜0.01)。结论 新蝶呤在社区颈动脉粥样硬化易损斑块人群中水平升高，提示可能作为颈动脉易损斑块的血清标志物，并提供一个反映炎症和血栓形成状态的选择手段。

Investigation on the relationship between neopterin and carotid atherosclerotic plaque stability in community population

Objective To investigate the relationship between neopterin levels, a specific marker of activated macrophage, and carotid atherosclerotic plaque stability evaluated by ultrasound. Methods 142 community residents in Guangzhou were investigated by carotid artery ultrasonography. According to the plaque characteristics, objects were divided into non-plaque group, hyperechoic group and hypoechoic group. Hypoechoic plaque was defined as a vulnerable plaque. Serum neopterin concentrations were measured by enzyme-linked immunosorbent assay. Subjects were divided into lowest, intermediate and highest groups according to the tertiles of neopterin values. Results The serum neopterin level of the hypoechoic plaque group（5.85.3-6.7] nmol/L） was significantly higher than that of the hyperechoic group（4.73.9-5.3]nmol/L）（P<0.01）and the non-plaque group（4.63.6-5.4] nmol/L）(P<0.01). The difference between the non-plaque group and the hyperechoic group was not significant (P=0.99). The proportion of hypoechoic plaque in the highest neopterin concentration group（59.6%）was significantly higher than that in the lowest concentration group（12.5%, P<0.01)and the intermediate concentration group（29.8%, P＜0.05), while the difference between the last two groups was not significant (P=0.12). A multivariate logistic regression analysis revealed that neopterin level was an independent factor for the prediction of vulnerable carotid atherosclerotic plaque. With per 1.0nmol/L (approximately one interquartile range) increased, the odds ratio (OR) value for vulnerable plaque were 2.60 (95%CI: 1.70-3.96, P＜0.01).Conclusion Circulating neopterin levels is increased in community population with vulnerable plaque and suggests a potential utility as a serological biochemical marker for the carotid vulnerable plaque, which can be served as an alternate approach in identifying an inflammatory, thrombosis-prone state.