冠状动脉重构的血管内超声研究

目的应用血管内超声探讨冠状动脉重构的病变特征及其与临床表现的关系。方法39例急性冠脉综合征患者与45例稳定性心绞痛患者进行冠脉造影及血管内超声检查，对病变进行定性和定量测定。包括外弹力膜血管面积（EEMA）、最小血管内膜腔面积、斑块面积、斑块体积及斑块的性状和重构指数，根据血管内超声斑块的性状分为软斑块和硬斑块（包括纤维斑块、钙化斑块和混合斑块）。重构指数（RI）=病变处EEMA／平均参考血管处EEMA。若RI〉1．0为正性重构，RI〈1．0为负性重构。结果正性重构及负性重构两组年龄、性别及冠心病危险因素等无明显差别，急性冠状动脉综合征的患者更多的表现为正性重构（61．4％vs30．0％，P〈0．01）。稳定性心绞痛的患者更多的表现为负性重构（70．0％vs38．6％，P〈0．01）。与负性重构相比，正性重构一般狭窄程度较轻，但病变部位的血管面积及斑块面积较大[（17．8±7．0）vs（13．6±4．9）mm^2，（12．2±5．5）vs（9．5±4．8）mm^2，P〈0．01），同时正性重构多为偏心性软斑块，发生钙化的较少。结论正性重构及负性重构的病理特征不同，正性重构病变以软斑块及偏心性斑块多见，冠状动脉重构与临床表现及斑块特征有关。     

Graphical comparison of coronary arterial culprit lesions in acute myocardial infarction and unstable angina pectoris

OBJECTIVE: The culprit lesion morphology at acute myocardial infarction (AMI) and unstable angina pectoris (UAP) was investigated by observing the responsible vessels through intravascular ultrasound (IVUS) during the acute stage. METHODS: As the subjects of study, 54 lesions of 54 ACS patients (26 in AMI patients, 28 in UAP patients) were enrolled prospectively from June 1994 to June 1998. The appearance of plaque in the lesion, the distal and proximal sites, extent of calcification, eccentricity, remodeling and shrinkage were observed through IVUS before the intervention. RESULTS: At lesion and distal site, significantly more soft plaques were observed in AMI than UAP. As to the extent of calcification in the former, mild calcification was noted significantly more in distal site as well as a tendency of more mild calcification in the lesion and proximal site. CONCLUSION: These results suggested that the condition of responsible coronary artery is involved in the onset mechanism of AMI and UAP.     

冠状动脉重构的血管内超声研究及基质金属蛋白酶和高敏C反应蛋白检测

目的用血管内超声(IVUS)对比研究不同类型冠心病患者的冠状动脉重构(remodeling)特点,探讨冠状动脉重构与临床表现、基质金属蛋白酶(MMPs)及高敏C反应蛋白(hs CRP)的关系。方法在行冠状动脉介入治疗前,应用IVUS研究38例急性冠状动脉综合征(ACS)和18例稳定性心绞痛(SA)患者,测量“罪犯”血管病变处及其近端、远端参考段的外弹力膜(EEM)面积、管腔面积,计算斑块面积和重构指数(RI),定义RI>1.05为正重构,RI<0.95为负重构。识别出高危斑块,检测外周血基质金属蛋白酶2(MMP2)、基质金属蛋白酶9(MMP9)和hs CRP水平。结果ACS组“罪犯”血管处的斑块面积大于SA组[(11.94±4.90)mm2比(9.17±3.36)mm2,P=0.035]。ACS组RI明显大于SA组(0.972±0.222比0.796±0.130,P=0.003)。两组正、负重构分布比率显著不同正重构在ACS组比SA组更常见(34.2%比5.6%,P=0.047),而负重构在SA组更常见(负重构在ACS组和SA组分别为52.6%与88.9%,P=0.003)。ACS组高危斑块发生率多于SA组(76.3%比50.0%,P=0.040)。ACS组患者血清MMP2高于SA组[(250.65±47.97)μg/L比(214.21±47.20)μg/L,P=0.029],前者的血浆MMP9也高于后者[(84.26±9.78)μg/L比(68.46±22.82)μg/L,P=0.038],前者的血清hs CRP亦高于后者[(3.62±3.37)mg/L比(1.48±1.52)mg/L     

Calcification in culprit lesions of coronary artery disease

Coronary calcification, a type of coronary atherosclerosis, has recently been closely examined in clinical cardiology because its presence may influence the selection of interventional therapy. In addition, plaque instability is one of the most important factors in the mechanism of acute coronary syndrome, and calcium deposit is frequently detected in advanced lesions. However, little is known about the clinical significance of coronary calcification. The incidence of calcium deposits was investigated in the culprit lesions (culprit coronary calcification) of patients with serious coronary artery disease to discover any cardioprotective effect. Initial coronary angiography was performed in 179 consecutive patients with acute myocardial infarction with Q wave on electrocardiography (AMI group; male 139, female 40, mean age 60.2 +/- 10 yr) and in 119 consecutive patients with stable effort angina pectoris (SAP group; male 78, female 41, mean age 63.8 +/- 8 yr) for which balloon plasty or bypass surgery was necessary from 1990 to 1997. Culprit coronary calcification was defined positive if the calcification deposit was present cinefluoroscopically within 5 mm from the culprit point. The culprit point was defined as the narrowest point after successful intracoronary thrombolytic therapy or the latest point to be dilated during a balloon inflation in direct or rescue percutaneous transluminal coronary angioplasty in the AMI group, and the narrowest point of the culprit lesion in the SAP group. There was no statistical difference in clinical background between the 2 groups other than male dominance in the AMI group and high incidence of family history of ischemic heart disease in the SAP group (p < 0.05). Culprit coronary calcification in patients over 50 years old was less frequently positive in the AMI group than the SAP group (26% vs 66%, p < 0.005, respectively). In younger patients under 50 years old, the incidence of culprit coronary calcification was low (14-15%) in both groups. Culprit coronary calcification was frequently positive in the right or the left anterior descending coronary artery in the SAP group (p < 0.005). There was no incidental sex difference of culprit coronary calcification. This comparison suggests that if a plaque contains cinefluoroscopically visible calcification, it may be regarded as less vulnerable or having a history of chronic process of atherosclerosis which results in protecting plaque rupture.     

Pathophysiological role of oxidized low-density lipoprotein in plaque instability in coronary artery diseases

Oxidized low-density lipoprotein (ox-LDL) is considered to play a key role in the genesis of inflammatory processes in atherosclerotic lesions. It has also been shown that LDL isolated from patients with diabetes mellitus (DM) has an enhanced susceptibility to oxidation. Recently, a sandwich ELISA method for measurement of plasma ox-LDL levels has been developed. To elucidate the role of ox-LDL in plaque instability in coronary artery disease, we measured the plasma ox-LDL levels in patients with acute myocardial infarction (AMI), unstable angina pectoris (UAP), and stable angina pectoris (SAP), and moreover assessed whether a relationship is present between plasma ox-LDL levels and DM. We also measured the plasma ox-LDL level in a patient who died of AMI, thus enabling us to study the presence of ox-LDL and CD 36, which is one of the ox-LDL receptors, in the culprit lesion. Plasma ox-LDL levels were measured in 210 patients (AMI: 70, UAP: 70, SAP: 70), and in 55 control subjects. Plasma ox-LDL levels in AMI patients were significantly higher than in UAP patients (P<.0001), SAP patients (P<.0001), or controls (P<.0001). In the UAP group, plasma ox-LDL levels in patients with DM were significantly higher than those without DM (P<.005). The autopsied patient who died of AMI revealed an increased plasma level of ox-LDL, and immunohistochemically, the culprit coronary lesion contained abundant macrophage-derived foam cells, showing distinct positivity for ox-LDL and CD 36. These results strongly suggest an important role for ox-LDL in the genesis of plaque instability in human coronary atherosclerotic lesions.     

Correlation between morphologic characteristics and local temperature differences in culprit lesions of patients with symptomatic coronary artery disease.

OBJECTIVES: The purpose of this study was to investigate the possible correlation between morphologic and functional characteristics of culprit lesions (CL) in patients with acute coronary syndromes (ACS) and chronic stable angina (CSA). BACKGROUND: Intravascular ultrasound (IVUS) provides morphologic assessment and intracoronary thermography (ICT) evaluates the local inflammatory activation of CL. METHODS: Eighty-one consecutive patients, 48 with ACS and 33 with CSA, were enrolled. Ratio of lesion to reference external elastic membrane area, indicated by IVUS, was defined as positive remodeling index (pRi) (> or =1) or negative remodeling index (nRi) (<1). We also investigated the existence of ruptured plaque (rp) in the CL. By ICT temperature difference (DeltaT) between the CL and the proximal vessel wall was measured. RESULTS: Patients with ACS had greater remodeling index than patients with CSA (1.15 +/- 0.18 vs. 0.90 +/- 0.12; p < 0.01), as well as increased DeltaT (0.08 +/- 0.03 degrees C vs. 0.04 +/- 0.02 degrees C; p < 0.01). Patients with pRi had higher DeltaT than patients with nRi (0.07 +/- 0.03 degrees C vs. 0.04 +/- 0.02 degrees C; p < 0.001). In patients with nRi there was no difference in DeltaT between ACS and CSA (p = 0.22). Patients with rp had increased DeltaT compared with patients without rp (0.09 +/- 0.03 degrees C vs. 0.05 +/- 0.02 degrees C; p < 0.01). Multivariate analysis showed that DeltaT was independently correlated with the presence of rp, pRi, and ACS. CONCLUSIONS: The present study showed that culprit lesions with plaque rupture and positive arterial remodeling have increased thermal heterogeneity, although in certain patients a discrepancy between morphogic and functional characteristics was observed. A combination of morphologic and functional examination may offer additional diagnostic and prognostic information.     

Impact of histological plaque characteristics on intravascular ultrasound parameters at culprit lesions in coronary artery disease

Prior intravascular ultrasound (IVUS) studies have demonstrated that a positive remodeling pattern of a culprit lesion is observed more frequently in acute coronary syndrome (ACS) than stable angina (SA). However, the relationship between the plaque morphology detected by IVUS and the histological type of atherosclerotic plaque has not been well defined. This is a prospective study on 37 consecutive patients who underwent directional coronary atherectomy. The 37 patients were divided into 2 groups; 21 patients with SA and 16 with ACS. Vessel and plaque cross sectional area were measured at the culprit lesion and the remodeling index (RI) was calculated by IVUS. The plaque tissue was assessed for the presence of inflammatory cells and lipids, and the presence of each was scored as 0 (absent), 1 (sparse), 2 (dense), or 3 (predominant). The RI of the patients with ACS was higher than that of SA. Inflammatory cells were present to a greater extent in patients with ACS. Inflammatory cells and lipids were significantly correlated with the RI (Inflammatory cell score grade > or = 2 patients; 1.14 +/- 0.13 versus grade 0 patients; 0.87 +/- 0.24, and grade 1 patients; 0.93 +/- 0.17, P < 0.01 and lipid score grade > or = 2 patients; 1.13 +/- 0.17 versus grade 0 patients; 0.85 +/- 0.18, P < 0.001 and grade 1 patients; 0.95 +/- 0.19, P < 0.05). The results clearly indicate that the evaluation of vessel morphology by vascular imaging is an important indicator of plaque instability.     

不稳定型心绞痛患者的血管内超声分析

目的:应用血管内超声(IVUS)探讨不稳定型心绞痛(UAP)患者的斑块形态学特点。方法:经冠状动脉造影和IVUS检查的冠心病患者57例,其中稳定型心绞痛(SAP)21例,UAP 36例,根据斑块回声的强度,将斑块分为软斑块、纤维斑块、钙化斑块、混合斑块和斑块破裂等,分析比较UAP和SAP患者的斑块的形态学特点。结果:IVUS发现软斑块的比例在SAP和UAP患者中分别为47.6%和75.0%,纤维斑块的比例分别为52.4%和25.0%,斑块破裂分别为0和30.6%,钙化斑块分别为52.4%和19.4%(均P<0.05)。结论:IVUS显示UAP的斑块形态学特点主要表现为软斑块和斑块破裂。     

D-二聚体定量检测对判定急性冠脉综合征血栓形成的研究

目的：探讨D-二聚体定量检测对于判定急性冠脉综合征（ACS）血栓形成的意义。方法：选择住院不稳定型心绞痛（UAP）患者36例,急性心肌梗塞（AMI）患者13例,稳定型心绞痛（SAP）患者23例,采用胶体金标法动态检测患者静脉血中的D-二聚体含量。结果：D-二聚体含量：UAP组（0．95±0．32）mg／L,AMI组（1．82±0．63）mg／L,UAP组与SAP组（0．39±0．15）mg／L比较有显著差异（P〈0．05）,AMI组与SAP组比较,差异非常显著（P〈0．01）。结论：D-二聚体定量检测是判定ACS血栓形成相对特异的敏感指标。     

血浆脂联素在冠心病患者中的变化及其临床意义

目的:观察冠心病患者血浆脂联素(APN)水平,及血浆APN水平与急性冠状动脉综合征(ACS)之间的关系。方法:经冠状动脉造影证实的冠心病患者共110例,其中稳定型心绞痛组35例,不稳定型心绞痛组42组,急性心肌梗死组33例,并且选取20例正常健康人作为对照组。采用ELISA法检测血浆APN水平,同时检测各组生化指标,如空腹血糖、TC、TG、LDL-C、HDL-C等。结果:急性心肌梗死组、不稳定型心绞痛组中血浆APN浓度显著低于稳定型心绞痛以及对照组。logistic多元逐步分析显示吸烟、空腹血糖以及低血浆APN浓度与ACS发生独立相关。结论:血浆APN可能是评估冠心病的新的独立危险因素,可能与ACS的发生有关。     

Independent roles of monocyte chemoattractant protein-1, regulated on activation, normal T-cell expressed and secreted and fractalkine in the vulnerability of coronary atherosclerotic plaques

Background:?Monocyte chemotactic factors contribute to the formation of atherosclerotic plaques. The present study aimed to elucidate the roles of monocyte chemoattractant protein-1 (MCP-1), Regulated on Activation, Normal T-cell Expressed and Secreted (RANTES) and fractalkine on the vulnerability of atherosclerotic plaques in patients with acute myocardial infarction (AMI) or unstable angina pectoris (UAP). Methods and Results:?Sixty patients with AMI, 60 patients with UAP, 60 patients with stable angina pectoris (SAP) and 40 patients without coronary heart disease comprised the study group. Quantitative coronary angiography and intravascular ultrasound (IVUS) were performed. Concentrations and mRNA expression levels of high-sensitivity C-reactive protein, MCP-1, RANTES and fractalkine were measured by ELISA and RT-PCR, respectively. IVUS found that 51.3% of the AMI patients and 47.7% of the UAP patients had soft lipid plaques. Among the SAP patients, 52.4% had fibrous plaques and only 17.1% had soft plaques. AMI and UAP patients had larger plaque burden and vascular remodeling index than did the SAP patients (P<0.01). The averaged number of migrated monocytes was higher in AMI and UAP patients. Concentrations and mRNA expression levels of MCP-1, RANTES and fractalkine were significantly higher in AMI and UAP patients than in SAP patients (P<0.05-0.01). The plaque burden in UAP patients as measured with IVUS correlated well with monocytes chemotaxis (r=0.56, P<0.01). Conclusions:?MCP-1, RANTES and fractalkine independently participate in the pathogenesis of plaque vulnerability and subsequent plaque rupture. (Circ J?2012; 76: 2167-2173).     

64排多层螺旋CT冠状动脉成像比较稳定性与不稳定性心绞痛患者冠状动脉粥样硬化斑块特征

目的 探讨64排多层螺旋CT冠状动脉成像比较稳定性心绞痛（SAP）与不稳定性心绞痛（UAP）患者粥样硬化斑块的特征.方法 对40例SAP患者、40例UAP患者进行64排多层螺旋CT冠状动脉成像,比较两组患者冠脉斑块的数量及斑块类型.对其中50例患者（26例UAP,24例SAP）罪犯斑块特征进行比较.结果 SAP组患者与UAP组患者斑块数量比较无显著性差异.UAP组患者非钙化性斑块、混合性斑块发生率较高.在对两组患者罪犯斑块特征进行比较的亚组分析中,UAP患者罪犯斑块非钙化性斑块、血管正性重构发生率以及血管重构指数明显高于SAP患者,在校正了年龄、性别、高血压病、糖尿病、高脂血症、吸烟等危险因素后,非钙化性斑块、血管正性重构与UAP显著相关.结论 64排多层螺旋CT冠状动脉成像显示：与SAP患者比较,UAP患者非钙化性斑块与混合性斑块发生率较高,罪犯斑块具有较高的非钙化性斑块及正性重构发生率.     

Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes.

OBJECTIVES: To evaluate the feasibility of noninvasive assessment of the characteristics of disrupted atherosclerotic plaques, the authors interrogated the culprit lesions in acute coronary syndromes (ACS) by multislice computed tomography (CT). BACKGROUND: Disrupted atherosclerotic plaques responsible for ACS histopathologically demonstrate large lipid cores and positive vascular remodeling. It is expected that plaques vulnerable to rupture should bear similar imaging signatures by CT. METHODS: Either 0.5-mm x 16-slice or 64-slice CT was performed in 38 patients with ACS and compared with 33 patients with stable angina pectoris (SAP) before percutaneous coronary intervention. The coronary plaques in ACS and SAP were evaluated for the CT plaque characteristics, including vessel remodeling, consistency of noncalcified plaque (NCP <30 HU or 30 HU 相似文献   

Levels of soluble adhesion molecules in various clinical presentations of coronary atherosclerosis

Adhesion molecules play an important role in the development and course of coronary atherosclerosis. In this study, soluble forms of vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1), E-selectin and P-selectin were evaluated in patients with various clinical presentations of coronary atherosclerosis and compared them to those with angiographically documented normal coronary arteries. Venous plasma samples were collected from 43 patients with acute myocardial infarction (AMI), 45 with unstable angina pectoris (UAP), 34 with stable angina pectoris (SAP) and 29 subjects with normal coronary arteries (control). The VCAM-1 level was significantly higher in patients with AMI (mean +/- SEM; 799.8 +/- 26.3 ng/ml) than those with UAP (644.2 +/- 26.7 ng/ml) and SAP (526 +/- 32.5 ng/ml) and controls (270 +/- 26.8 ng/ml). In patients with UAP, VCAM-1 was found to be significantly elevated as compared to the SAP group and controls. VCAM-1 level was also higher in SAP group than the controls. Serum levels ICAM-1 were similar among patients with AMI (424.1 +/- 15.2 ng/ml), UAP (403 +/- 12.3 ng/ml) and SAP (381.2 +/- 16.2 ng/ml); however, levels of ICAM-1 was significantly elevated in these groups as compared to the controls (244.3 +/- 11). The mean level of E-selectin was not different in AMI and UAP groups (47.2 +/- 2.2 vs. 42.6 +/- 2.1 ng/ml; respectively). However, it was significantly higher in acute coronary syndrome groups as compared to SAP (33.4 +/- 2.3 ng/ml) and control subjects (30.7 +/- 1.9 ng/ml). Serum levels of E-selectin were similar in SAP group and controls. For P-selectin, no significant difference was observed between AMI and UAP groups (187.5 +/- 7.2 vs. 181.7 +/- 4.7 ng/ml; respectively), however, it was significantly higher in both groups as compared to SAP group (146.1 +/- 7.4 ng/ml) and controls (108 +/- 6.6 ng/ml). Serum level of P-selectin was significantly higher in patients with SAP than the control group. In conclusion, determination of serum VCAM-1, E-selectin and P-selectin levels seems more useful for detecting coronary plaque destabilization.     

Angiographic coronary morphology in patients with ischemic heart disease

OBJECTIVES: To determine whether ischemia- or infarct-related arteries (IRAs) are accompanied by certain findings specific to clinical settings, coronary cineangiography was reviewed of 71 patients with stable effort angina pectoris (SAP), 72 with unstable angina pectoris (UAP), 118 with acute myocardial infarction (AMI) and 137 with old myocardial infarction (OMI). METHODS: The morphology of identifiable ischemia- or infarct-related lesions (IRLs) was classified as totally occlusive, and simple (Type I lesion) or complex (Type II lesion). Complex lesions were subdivided into Type IIa lesions (narrowing with irregular, poorly defined or hazy borders, sharp leading or trailing edges that overhang or are perpendicular to vessel walls, and globular endoluminal negative images), Type IIb (2 or more serial, closely spaced narrowings together with multiple irregularities), Type IIc (luminal narrowing with extraluminal contrast pooling, single or paired short thin linear radiolucencies with or without a variable degree of outpouching, and narrowing with definite outpouching with or without radiolucency), and Type IId (narrowing with morphology not included in Types IIa-IIc). RESULTS: Total occlusive lesions among identifiable IRLs occurred at 17 sites (23.9%) in patients with SAP, 7 (9.7%) with UAP, 48 (40.7%) with AMI and 30 (21.9%) with OMI. The mean diameter stenosis of identifiable IRLs was 89.4% in patients with SAP, 92.0% with UAP, 93.1% with AMI, and 87.4% with OMI. Patent identifiable IRLs in patients with SAP had a significantly higher frequency of Type I lesions (29 sites, 40.8%) compared with those with UAP, AMI and OMI (p < 0.01), followed by a relatively lower occurrence of Types IIa 12 (16.9%), IIb 8 (11.3%), IIc 3 (4.2%) and IId 2 (2.9%) lesions. Patients with UAP were characterized by a higher occurrence of Type IIa (34 sites, 47.2%, p < 0.01) and IIc (13 sites, 18.1%, p < 0.01) lesions compared with those with SAP. Patients with AMI had total occlusion (48 sites, 40.7%, p < 0.05) and Type IIa lesion (38 sites, 32.2%, p < 0.05) more frequently than those with SAP. Patients with OMI showed fewer total occlusions (30 sites, 21.9%), same occurrence of Type IIa lesion (39 sites, 28.5%), and higher occurrence of IIb (23 sites, 16.8%) and IIc (20 sites, 14.6%) than those with AMI. CONCLUSIONS: This analysis of coronary cineangiographies from patients with UAP, AMI and OMI, which share a common pathogenesis, shows that IRAs, especially IRLs, are associated with certain morphology specific to clinical settings, and that the morphology and severity of stenosis could change in a short period. The present results may improve coronary cineangiography interpretation about pathophysiological issues in vivo affecting coronary circulation.     

Recurrent unstable angina after directional coronary atherectomy is related to the extent of initial coronary plaque inflammation

OBJECTIVES: This study was performed to evaluate the relationship between plaque inflammation of the initial culprit lesion and the incidence of recurrent angina for one year after directional coronary atherectomy (DCA). BACKGROUND: A positive correlation between coronary plaque inflammation and angiographic restenosis has been reported. METHODS: A total of 110 patients underwent DCA. Cryostat sections were immunohistochemically stained with monoclonal antibodies CD68 (macrophages), CD-3 (T lymphocytes) and alpha-actin (smooth muscle cells [SMCs]). The SMC and macrophage contents were planimetrically quantified as a percentage of the total tissue area. T lymphocytes were counted as the number of cells/mm2. The patients were followed for one year to document recurrent unstable angina pectoris (UAP) or stable angina pectoris (SAP). RESULTS: Recurrent UAP developed in 16 patients, whereas recurrent SAP developed in 17 patients. The percent macrophage areas were larger in patients with recurrent UAP (27 +/- 12%) than in patients with recurrent SAP (8 +/- 4%; p = 0.0001) and those without recurrent angina (18 +/- 14%; p = 0.03). The number of T lymphocytes was also greater in patients with recurrent UAP (25 +/- 14 cells/mm2) than in patients with recurrent SAP (14 +/- 8 cells/mm2; p = 0.02) and those without recurrent angina (14 +/- 12 cells/mm2; p = 0.002). Multiple stepwise logistic regression analysis identified macrophage areas and T lymphocytes as independent predictors for recurrent UAP. CONCLUSIONS: There is a positive association between the extent of initial coronary plaque inflammation and the recurrence of unstable angina during long-term follow-up after DCA. These results underline the role of ongoing smoldering plaque inflammation in the recurrence of unstable angina after coronary interventions.     

急性冠状动脉综合征患者外周血Th1/Th2细胞因子水平的变化

目的通过检测急性冠状动脉综合征(ACS)患者血清中1型辅助性T细胞/2型辅助性T细胞(Th1/Th2)细胞因子的变化,探讨细胞因子变化在斑块活化和进展评估中的作用。方法 ACS患者64例,其中急性心肌梗死22例,不稳定型心绞痛42例,同时选取稳定型心绞痛患者34例及正常对照22例。测定血清中的γ干扰素(IFN-γ)、白细胞介素-2(IL-2)I、L-4和IL-10水平,所有患者均行冠脉造影检查。结果 ACS患者外周血Th1细胞因子水平明显高于、而Th2细胞因子水平则明显低于正常对照组和稳定型心绞痛组。依据冠脉斑块形态分为两型,Ⅱ型斑块患者血清中的Th1细胞因子水平显著高于Ⅰ型斑块患者;Ⅱ型斑块患者Th2细胞因子显著低于Ⅰ型斑块患者。结论外周血中Th1/Th2细胞因子水平的失衡与ACS的发生密切相关,对斑块的活化和进展有一定的量化评估作用。     

急性冠状动脉综合征患者血清BNP水平与hs-CRP、cTNI水平的相关性研究

目的探讨急性冠状动脉综合征(ACS)患者血清脑利钠肽(BNP)与高敏C反-应蛋白(hs-CRP)、心肌肌钙蛋白I(cTNI)指标的相关性及其在ACS患者危险分层中可能的临床意义。方法ACS患者41例包括急性心肌梗死患者21例和不稳定型心绞痛患者20例;稳定型心绞痛患者29例和与之年龄、性别等相匹配的30例对照者进入本研究。酶联免疫吸附法测定血清BNP水平,免疫比浊法测定hs-CRP水平,化学发光法测定cTNI水平。结果急性心肌梗死组和不稳定型心绞痛组患者的血清BNP水平均明显高于稳定型心绞痛和对照组患者,差异均具有统计学意义(P<0.01和P<0.05);在ACS组中,BNP与cTNI和hs-CRP具有相关性(r分别为0.67和0.91,P<0.05)。结论①血清BNP水平在ACS患者中明显升高,可作为辅助诊断指标之一。②ACS患者血清BNP水平升高程度与同期测定的血清hs-CRP、cTNI水平呈显著正相关。     

冠心病与免疫反应关系的临床研究

目的 探讨免疫反应与冠心病（CAD）之间的关系。方法 将42例经冠状动脉（冠脉）造影证实其冠脉有异常改变的CAD患者和20例经冠脉造影证实其冠脉无异常改变的非冠心病患者（NCAD）作为观察对象；CAD患者包括稳定型心绞痛（ASP）17例、不稳定型心绞痛（UAP）12例和急性心肌梗死（AMI）13例，并测定其下述指标；免疫球蛋白IgG、IgA、IgM和补体C3、C4。结果 AMI组的IgG、IgA、C3和C4水平及四组间的IgM水平比较差异无显著性。结论 IgG、IgA、C3和C4水平的增高与冠心病的发生密切相关。     

血管内超声分析斑块组成与冠状动脉重构之间的关系

目的 本研究的目的旨在应用血管内超声显像(IVUS)技术探讨斑块组成与冠状动脉重构之间的关系.方法 对77例冠心病患者(男性53例,平均年龄58±10岁)的罪犯血管采用ClearView或Galaxy2 (美国波士顿科学公司)血管内超声显像仪进行IVUS检查,其中31例为稳定性心绞痛,46例为急性冠状动脉综合征.对病变进行定性和定量测定.根据斑块组成回声的不同,分为软斑块、纤维斑块、钙化斑块和混合斑块,后三者统称为硬斑块.重构指数(RI)=病变处血管横截面积/平均参考血管面积.若RI＞1.0为正性重构;RI＜1.0为负性重构.比较不同重构形式病变的特性.结果 77处病变中,45处(58%)发生正性重构,32处(42%)发生负性重构.比较两组患者的临床表现,正性重构的患者更多的表现为急性冠状动脉综合征(74%比43%, P=0.006).与负性重构相比,正性重构病变部位的斑块面积和血管面积较大,斑块组成更多为软斑块(71%比34%, P＝0.001),发生钙化的较少(21%比54%, P＝0.003),钙化范围也较小[(18±37)°比(40±50)°, P＝0.027].进行多因素回归分析后,斑块组成和临床表现在两组患者中的差别仍具有统计学意义.结论冠状动脉重构与临床表现及斑块组成有关,正性重构病变软斑块较多见且钙化较少.