血脂与血管内超声-虚拟组织学评价冠状动脉粥样硬化斑块性质

目的:探讨血脂和血管内超声-虚拟组织(IVUS-VH)学评价急性冠脉综合征(ACS)和稳定性心绞痛(SA)患者冠状动脉粥样硬化斑块性质。方法:对44例ACS患者及22例SA患者行IVUS-VH分析,并对其血清高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a[LP(a)]进行测定,计算LDL-C/HDL-C比值,分析冠状动脉粥样硬化斑块坏死核心(NC)所占的比例与LP(a)、LDL-C/HDL-C的相关关系。结果:ACS组斑块中NC和钙化组织比例明显高于SA组(t=4.669、9.894,P<0.001),而纤维组织及纤维脂肪组织则明显低于SA组(t=7.184、5.290,P<0.001)。ACS组患者血清LDL-C/HDL-C、LP(a)水平高于SA组患者(t=3.512、19.139,P<0.001)。ACS组患者冠状动脉粥样硬化斑块中NC比例与血清LP(a)水平有显著的相关性(r=0.549,P<0.001)。结论:LP(a)可能代替IVUS-VH帮助了解冠状动脉粥样硬化斑块的性质。

Correlation between blood lipid and intravascular ultrasound-virtual histology in assessing characteristics of coronary atherosclerotic plaques

Aim:To investigate the correlation between blood lipid and intravascular ultrasound-virtual histology(IVUS-VH) in assessing characteristics of the coronary atherosclerotic plaques in patients with acute coronary syndrome(ACS) and stable angina(SA).Methods:The coronary atherosclerotic plaques in 44 patients with ACS and 22 patients with SA were tested by IVUS-VH,and the serum levels of HDL-C,LDL-C and LP(a) were detected.The ratio of LDL-C/HDL-C was calculated.The correlation of the percentage of necrotic core and LP(a),LDL-C/HDL-C was analyzed,respectively.Results:The percentages of necrotic core and dense calcium tissue in ACS were significantly higher than those in SA group(t=4.669,9.894,P<0.001),but the percentages of fibrous tissue and fibro-fatty tissue in ACS were significantly lower than those in SA group(t=7.184,5.290,P<0.001).There were obvious differences in serum level of LP(a) and the ratio of LDL-C/HDL-C between ACS group and SA group(t=3.512,19.139,P<0.001).There was a significant positive correlation between the percentage of necrotic core and serum level of LP(a)(r=0.549,P<0.001).Conclusion:LP(a) may be take the place of IVUS-VH to understand the characteristics of the coronary atherosclerotic plaques and guide the clinical practice.