冠状动脉内膜剥脱斑块脂质分析及影响术后再狭窄机制初探

目的:分析冠状动脉内膜剥脱斑块的脂质成分，并探讨其影响内膜剥脱术(coronary endarterectomy，CE)中、长期疗效的机制。方法:自2018年1月至2019年12月，选取北京安贞医院冠状动脉外科术前合并高脂血症病史的弥漫性冠状动脉病变(diffuse coronary artery disease，DC...

Lipid analysis of coronary atherosclerotic plaques and the mechanism of restenosis after coronary endarterectomy

Objective To analyze the lipid composition of coronary atherosclerotic plaques and explore the mechanism of its influence on the medium and long-term efficacy of coronary endarterectomy(CE).Methods From January 2018 to December 2019,a total of 50 patients with diffuse coronary artery disease(DCAD)and hyperlipidemia in Beijing Anzhen Hospital were enrolled to undergo coronary artery bypass grafting combined with anterior descending CE.After the informed consent was signed before the operation,the coronary endarterectomy plaque tissue and blood plasma samples were taken during the operation.Patients were further examined by coronary atherosclerosis T1-weighted characterization(CATCH)and power domain non-orthogonal multiple access(NOMA)postoperatively to analyze middle and long-term coronary restenosis risks.They were divided into high-risk group(restenosis rate>25%,study group)and matched low-risk group(control group).Lipid and molecular biological analysis were performed in the two groups to detect the tissue and cytochrome P4503A4 enzyme(CYP3A4)content of plaque samples.Results 8 patients were enrolled in each group.The lipid analysis showed that and tissue samples from patients in the study group had a significantly higher level of 4α-Hydroxycholesterol(4α-OHC)as compared to the control group(0.050μmol/g vs.0.016μmol/g,P<0.05).Further,12 months after the operation,CATCH results showed that the patency rate of the control group was better than that of the study group[coronary artery stenosis rate(9.01±1.9)%vs.(22.31±2.3)%,P<0.05].Comparison of CYP3A4 content showed that:the CYP3A4 in blood plasma for the study group was higher than that in the control group[immediate(0.88±0.05)ng/ml vs.(0.45±0.03)ng/ml and(2.08±0.40)ng/ml vs.(1.58±0.16)ng/ml,P<0.05].Conclusion High expression of 4α-OHC may accelerate atherosclerosis(AS)after CE and cause restenosis in the middle and long term;It was also confirmed that 4α-OHC is a biomarker of CYP3A4,which suggests for further investigation of the mechanism of progression after CE.