脂蛋白(a)水平与VH-IVUS检测冠脉粥样硬化斑块成分的关联性分析

目的: 利用虚拟组织学血管内超声(VH-IVUS)评价冠心病(CHD)患者冠状动脉病变斑块成分与脂蛋白 (a)[Lp (a)]的关系,探讨Lp (a)在斑块易损机制中的作用。 方法: 选择54例胸痛患者,依据患者症状及冠状动脉造影(CAG)结果分为非ST段抬高型急性冠脉综合征组 (NSTEACS)18例、稳定型心绞痛(SAP)组21例及对照组(CAG显示管腔未见异常者)15例。测定患者血清生化指标,采用VH-IVUS检查NSTEACS和SAP组患者病变斑块,分析斑块成分与Lp (a)关联性。 结果: 与对照组比较,NSTEACS组和SAP组患者Lp (a)、低密度脂蛋白(LDL)和超敏C反应蛋白(hs-CRP)水平明显升高(P<0.05),且NSTEACS组患者血清Lp (a)、hs-CRP和LDL水平高于SAP组(P<0.05)。与SAP组比较,NSTEACS组患者病变斑块含坏死组织(NC)、纤维脂质(FF)成分百分比和易损斑块(TCFA)发生率明显增高 (P<0.05)。 Lp (a)与斑块中含NC、FF成分百分比及TCFA发生率和血清hs-CRP水平呈正相关关系(r分别为0.411、0.312、0.318和0.309),差异有统计学意义(P<0.05)。 结论: NSTEACS患者斑块不稳定随 Lp (a)升高而增加。Lp (a)是反映易损斑块的敏感性指标。

Analysis on correlation between lipoprotein (a) and VH-IVUS examination of atherosclerotic plaque in patients with CHD

Objective: To analyze the characteristics of atherosclerotic plaques in the patients with coronary heart disease (CHD)by virtual histology intravascular ultrasound (VH-IVUS),and to discuss their correlations with lipoprotein (a) ［Lp(a)］.Methods: 54 patients with chest pain were divided into non ST elevation acute coronary syndromes (NSTEACS)group (n=18),stable angina pectoris (SAP)group(n=21)and control group (n=15)according to the symptoms and coronary angiography results of the patients.The serum biochemical indexes were measured in all patients.In 39 CHD patients,culprit lesions were detected with VH-IVUS to investigate the characteristics of atherosclerotic plaques and their relevance with Lp(a). Results:The levels of Lp(a),low density lipoprotein (LDL)and hypersensitive C reactive protein (hs-CRP)of the patients in NSTEACS and SAP groups were significantly higher than those in control group (P< 0.05);the levels of serum Lp(a),hs-CRP and LDL in NSTEACS group were higher than those in SAP group(P<0.05).The incidence of necrotic tissue (NC),fiber lipid (FF),and vulnerable plaque (TCFA)in lesion patches of the patients in SAP group were significantly decreased(P<0.05)compared with NSTEACS group.The plasma Lp(a) was positively associated with NC,FF,TCFA serum and hs-CRP (r =0.411,r =0.312,r =0.318,r =0.309,P<0.05).Conclusion: The vulnerability of plaques in the NSTEACS patients in creases with the increase of Lp(a) level:Plasma Lp(a) is a sensitive index for evaluating the plaque vulnerability.