血尿酸水平与冠状动脉薄纤维帽粥样硬化斑块的相关性研究

目的:利用光学相干断层扫描技术(OCT)研究血尿酸水平与薄纤维帽粥样硬化斑块(TCFA)之间的相关性。方法:入选2015-01-2018-02在新疆医科大学第一附属医院心脏中心住院治疗的冠心病患者129例。所有患者均经冠状动脉造影术确诊,采用OCT测定冠状动脉粥样硬化斑块参数。采用多重线性回归的统计方法分析血清尿酸水平与TCFA的关系。结果:①基于OCT结果将129例患者分为非TCFA组(96例)和TCFA组(33例),在单因素分析中,两组患者的性别、吸烟、2型糖尿病、体质指数(BMI)、肾小球滤过率(eGFR)、尿酸、低密度脂蛋白胆固醇(LDL-C)等比较,差异有统计学意义(P0.05);在多因素logistic回归分析中,吸烟、2型糖尿病、LDL-C、尿酸为TCFA的影响因素(分别为P=0.016、P=0.007、P=0.005、P=0.025),且为TCFA发生的预测因子,其中血尿酸是其独立危险因素(OR=1.007,95%CI:1.001～1.014,P=0.025);②根据血尿酸水平将患者分为高尿酸(420μmol/L)组(27例)与低尿酸(420μmol/L)组(102例),两组在纤维帽厚度、脂质弧、巨噬细胞评级、斑块破裂、血栓方面均差异有统计学意义(分别为P0.001、P=0.002、P=0.025、P=0.007、P=0.001)。结论:TCFA的发生率与患者血尿酸水平升高独立相关,斑块不稳定与血尿酸水平有关。     

胆固醇代谢标志物与冠状动脉SYNTAX评分的相关性研究

目的:探讨冠心病患者胆固醇代谢标志物水平与反映冠状动脉病变严重程度的SYNTAX评分的关系。方法:回顾分析在我院接受冠状动脉造影检查的冠心病患者共103例,根据冠状动脉造影结果计算SYNTAX评分,根据评分数值分为低、中、高危组,检测所有患者接受调脂治疗前胆固醇代谢标志物的水平,分析胆固醇代谢标志物与SYNTAX评分之间的关系。结果:SYNTAX评分中危组较低危组患者的菜油固醇、谷固醇水平均显著增高(P<0.05),提示随着胆固醇吸收标志物水平的升高,冠状动脉病变严重程度加重。相关性分析显示:菜油固醇、谷固醇与SYNTAX评分呈正相关。多元线性回归分析结果显示:谷固醇(B=0.233,P=0.043)与SYNTAX评分呈正相关。结论:胆固醇吸收标志物与SYNTAX评分正相关,可作为判断冠状动脉病变严重程度的参考指标之一。     

冠状动脉不稳定粥样斑块血液标志物的研究进展

急性冠状动脉综合征（ACS）发病急、危害严重，其基本原因为不稳定粥样斑块破裂引起血栓形成，造成冠状动脉严重狭窄或堵塞，导致心肌缺血或坏死。因此，早期识别或发现不稳定斑块的存在并及时治疗具有十分重要的临床意义。本文综合分析多种与不稳定粥样斑块相关的化学标志物，评价其特点、相关性及应用前景。     

老年急性冠状动脉综合征

急性冠状动脉综合征(acutecoronary syndromes,ACS),是以冠状动脉粥样硬化斑块破溃,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。以老年人发病居多。美国急性心肌梗死(AMI)住院病人中,≥65岁的老年人≥60%,其病死者≥80%;再者>75岁的老年人占AMI住院病人的37%,     

急性冠状动脉综合征患者非罪犯斑块稳定性的研究进展

急性冠状动脉综合征(acute coronary syndrome,ACS)是目前导致冠心病患者死亡的首要病因。未来10年内,我国ACS患病及死亡人数仍将快速增长。尽管临床上采取积极的药物及冠状动脉介入等干预治疗策略,但我国城乡居民ACS发病率及死亡率仍呈上升趋势[1]。目前ACS诊断的金标准仍为冠状动脉造影,冠心病常规以冠状动脉造影来判定介入治疗的适应证及评估治疗效果,但造影获取的信息量十分有限,最大的缺陷是无法确定ACS前期病变,即易损斑块的特征性信息。有研究表明,动脉粥样硬化斑块组织成分以及结构特性决定其危险度,且影响冠心病患者预后[2]。既往研究认为,心血管急性事件的发生与冠状动脉狭窄程度密切相关[3]。近年来越来越多的研究证实,冠状动脉血管轻、中度狭窄时发生急性冠状动脉事件的风险与高度狭窄并无明显差别,而易损斑块的破裂及血栓形成才是导致急性冠状动脉事件发生的决定因素[4-5]。因此,冠状动脉造影并不能精准评估ACS罪犯斑块特征、危险程度及预后,亦无法实现易损斑块的早期精准干预和指导制订个体化精准治疗策略。因此,亟需具有足够分辨率和精准度的腔内影像学技术来实现ACS斑块形态学特征的在体评估。     

急性心肌梗死循环标志物与罪犯斑块特点及其临床意义

目前急性心肌梗死标准治疗以血运重建、双联抗血小板治疗和降脂治疗为核心,没有充分考虑冠状动脉罪犯斑块病理类型、斑块下微结构和全身生物学风险等因素,可能是急性心肌梗死患者标准治疗后事件发生的主要原因。因此,针对急性心肌梗死患者的精准治疗策略是临床中亟待解决的问题。近年来研究表明,体循环标志物可以帮助判别急性心肌梗死患者冠状动脉斑块特征并提高传统预后模型的准确性,有望成为识别斑块类型及实现早期风险分层的重要手段。     

妊娠相关性血浆蛋白A--急性冠脉综合征的标志物

血循环中出现的提示动脉粥样硬化斑块不稳定性的标志物 ,对不稳定性心绞痛 (UAP)和急性心肌梗死 (AMI)可能有一定的诊断价值。妊娠相关性血浆蛋白 A(PAPP- A)是一种高分子量的锌结合金属蛋白酶 ,它最早发现孕妇血液中 ,后被证实在男性、女性体内均存在 ,近年来又发现它是一种动脉粥样硬化的介导因素之一——胰岛素样生长因子 - I(IGF- I)的一种特异性激活剂。本文评价 PAPP- A在急性冠脉综合征 (ACS)的诊断价值。作者对 8例心源性猝死患者进行研究 ,检查直接取自 8个不稳定性斑块和 4个稳定性斑块的标本 ,用免疫组化法定性测定 P…     

炎症标志物与急性冠状动脉综合征

动脉粥样硬化性疾病是一种慢性、非特异性、炎性疾病。在动脉粥样硬化性疾病的不同临床表现过程中,炎症与其发生和发展的所有阶段有关。急性冠状动脉综合征是冠心病的特殊疾病谱,新近研究证实,炎症在急性冠状动脉综合征患者的粥样斑块破裂与血栓形成中起主要作用。炎症与易损斑块的形成有关;临床试验证据支持炎症在急性冠状动脉综合征发生中的病因学地位;炎症标志物的使用,也提供了一个了解急性冠状动脉综合征病理生理机制的窗口。因此,急性冠状动脉综合征可以认为是一种心血管急性炎症综合征。     

红细胞膜脂质与急性冠脉综合征斑块易损性的相关性研究

斑块的易损性是急性冠脉综合征主要病理生理机制。而斑块内出血和新生血管的形成在易损斑块的形成中起着重要的作用,这其中红细胞膜脂质可能发挥着巨大的作用,它们通过不同的机制使斑块从稳定发展为不稳定。     

急性冠状动脉综合征患者不稳定性斑块的血管内超声

目的观察急性冠状动脉综合征患者不稳定性斑块的血管内超声特征.方法 36例急性冠状动脉综合征患者和20例稳定型心绞痛患者进行冠状动脉造影及血管内超声检查.应用血管内超声分别观察比较冠状动脉内斑块的性质,同时测量冠状动脉病变部位及其参考部位的血管外弹力膜面积、管腔面积、斑块面积及管腔面积狭窄率,并计算斑块的偏心指数及血管重构指数.结果急性冠状动脉综合征患者中脂质斑块占77.8%(28/36),其中10例发生斑块破裂及血栓形成;稳定型心绞痛患者主要为纤维性斑块及混合性斑块,脂质斑块仅占10%(2/20),无斑块破裂及血栓形成.两组斑块的特征包括偏心性、外弹力膜面积、斑块面积及管腔面积狭窄率具有显著性差异.不稳定性斑块呈现明显的正性重构,占72.2%(26/36),而稳定性斑块主要表现为负性重构,占75%(15/20).结论血管内超声能够准确地识别动脉粥样硬化不稳定性斑块,为早期临床发现不稳定性斑块并预测斑块破裂奠定了基础.     

Association between abdominal fat distribution and coronary plaque instability in patients with acute coronary syndrome

Background and aimsThis study aimed to assess possible association of detailed abdominal fat profiles with coronary plaque characteristics in patients with acute coronary syndrome (ACS).Methods and resultsIn 60 patients with ACS, culprit arteries were evaluated at 1-mm intervals (length analyzed: 66 ± 28 mm) by grayscale and integrated backscatter intravascular ultrasound (IB-IVUS) before percutaneous coronary intervention. Standard IVUS indexes (as a volume index: volume/length), plaque components (as percent tissue volume) and fibrous cap thickness (FCT) were assessed by IB-IVUS. Plain abdominal computed tomography was performed to evaluate subcutaneous adipose tissue (SAT) area, visceral adipose tissue (VAT) area, and VAT/SAT ratio. While SAT area only correlated with vessel volume (r = 0.27, p = 0.04), VAT area correlated positively with vessel (r = 0.30, p = 0.02) and plaque (r = 0.33, p = 0.01) volumes and negatively with FCT (r = −0.26, p = 0.049), but not with percent plaque volume and plaque tissue components. In contrast, higher VAT/SAT ratio significantly correlated with higher percent lipid (r = 0.34, p = 0.008) and lower percent fibrous (r = −0.34, p = 0.007) volumes with a trend toward larger percent plaque volume (r = 0.19, p = 0.15), as well as thinner FCT (r = −0.53, p < 0.0001). In the multiple regression analysis, higher VAT/SAT ratio was independently associated with higher percent lipid with lower percent fibrous volumes (p = 0.03 for both) and thinner fibrous cap thickness (p = 0.0001).ConclusionCoronary plaque vulnerability, defined as increased lipid content with thinner fibrous cap thickness, appears to be more related to abnormal abdominal fat distribution, or so-called hidden obesity, compared with visceral or subcutaneous fat amount alone in patients with ACS.     

急性冠状动脉综合征患者血清脂肪细胞因子的变化与冠状动脉病变程度的关系

目的观察急性冠状动脉综合征(acute coronary syndrome,ACS)患者血清脂肪细胞因子:脂联素、瘦素、抵抗素水平变化及其对冠状动脉病变程度的影响。方法选择2009年1月~2011年10月在我院经冠状动脉造影确诊为ACS的患者95例作为ACS组,另选择冠状动脉造影正常的95例作为对照组。ACS组根据病变支数分为单支组(43例)、双支组(33例)、三支组(19例)。所有患者检查脂联素、瘦素、抵抗素水平及生化检查。结果 ACS组抵抗素[(4.63±1.44)μg/L vs(2.42±0.93)μg/L,P=0.017]、瘦素[(9.60±1.39)μg/L vs(6.70±1.38)μg/L,P=0.009]水平明显高于对照组,脂联素[(8.99±1.66)μg/L vs(12.11±1.97)μg/L,P=0.006]水平明显低于对照组。随着病变支数增多,脂联素水平明显降低,瘦素、抵抗素水平明显升高,差异有统计学意义(P<0.05)。logistic回归分析,ACS患者的脂联素OR=0.078,95%CI:0.017~0.364,P=0.001;抵抗素OR=16.56,95%CI:2.298~119.280,P=0.005;瘦素OR=7.17,95%CI:1.594~32.261,P=0.010。结论脂联素、瘦素、抵抗素在诊疗ACS方面具有重要价值。     

Association between non-culprit healed plaque and plaque progression in acute coronary syndrome patients: an optical coherence tomography study

BACKGROUNDHealed plaques are frequently found in patients with acute coronary syndrome, but the prognostic value is debatable. This study investigated the clinical features of non-culprit healed plaques detected by optical coherence tomography (OCT) with the aim of predicting plaque progression of healed plaques.METHODSThis study retrospectively analyzed 113 non-culprit lesions from 85 patients who underwent baseline OCT imaging and follow-up angiography from January 2015 to December 2019. Plaque progression predictors were assessed by multivariate analysis.RESULTSAmong 113 non-culprit lesions, 27 healed plaques (23.9%) were identified. Patients with non-culprit healed plaques had prior antiplatelet therapy (65.0% vs. 33.8%, P = 0.019), hypertension (85.0% vs. 50.7%, P = 0.009), and dyslipidemia (70.0% vs. 41.5%, P = 0.04) which were more frequently than those without healed plaques. The thickness (r = 0.674, P < 0.001), arc ( r = 0.736, P < 0.001), and volume ( r = 0.541, P = 0.004) of healed plaque were correlated with minimum lumen diameter changes. At a mean follow-up of 11.5 months, the non-culprit healed plaques had a lower minimum lumen diameter (1.61 ± 0.46 mm vs. 1.91 ± 0.73 mm, P = 0.016), lower average lumen diameter (1.86 mm vs. 2.10 mm, P = 0.033), and a higher degree of diameter stenosis (41.4% ± 11.9% vs. 35.5% ± 13.1%, P = 0.031) when compared to baseline measurements. The plaque progression rate was higher in the healed plaque group (33.3% vs. 8.1%, P = 0.002), and multivariate analysis identified healed plaques [odds ratio (OR) = 8.49, 95% CI: 1.71−42.13] and lumen thrombus (OR = 10.69, 95% CI: 2.21−51.71) as predictors of subsequent lesion progression. CONCLUSIONSHealed plaques were a predictor for rapid plaque progression. The quantitative parameters of healed plaque showed a good agreement with plaque progression. Patients with healed plaque were associated with prior antiplatelet therapy and high level of low-density lipoprotein cholesterol. Bifurcation lesions might be the predilection sites of healed plaques.

Coronary artery diseases originate from pathological changes in the vessel endothelium, present as plaque development and lumen stenosis, that finally lead to clinical coronary symptoms.^[1] Finding the ideal time to intervene in the atherosclerosis process is difficult, especially with non-culprit lesions.^[2–4] Revascularization benefits are challenged by the quick progression of previously untreated mild to moderate lesions.^[2] Several clinical trials suggested that the rapid step-wise pattern of plaque growth may play an important role in lumen narrowing.^[5,6] This mechanism was described as a healing process that was initiated by a plaque rupture or erosion to protect the integrity of the vessel structure.^[7,8] Re-endothelialization results in a new layer of organized thrombus and collagen distinguished from the underlying ruptured or eroded site,^[9] and plaques with two or more layers of different densities are called healed plaques or layered plaques.^[8,10] Autopsy studies found that healed plaques were frequent in patients dying of sudden death or asymptomatic myocardial infarction.^[11] Optical coherence tomography (OCT) is a high-resolution intravascular imaging tool that is highly sensitive and specific for in vivo identification of layered plaque patterns by histopathology.^[12,13] A previous OCT study suggested that layered plaques at the culprit site were associated with more vulnerable features and a high degree of lumen stenosis in patients with acute coronary syndrome (ACS).^[14] However, serial observations of plaque progression at the exact site were only reported in rare cases.^[15] In this study, we investigated the OCT features, quantitative parameters, and predictive value of non-culprit healed plaques, which may help minimize plaque progression and stenosis risk.     

急性冠状动脉综合征患者血清中性粒细胞百分比与白蛋白比值与冠状动脉分层斑块的相关性

目的]研究血清中性粒细胞百分比与白蛋白比值(NPAR)水平与急性冠状动脉综合征(ACS)患者冠状动脉分层斑块的相关性。 [方法]选取2018年1月─2023年1月于新疆医科大学第一附属医院心脏中心行冠状动脉造影(CAG)和造影后即刻对罪犯血管行光学相干断层成像(OCT)检查并确诊为ACS的患者222例作为研究对象,根据图像结果分为分层斑块组111例和非分层斑块组111例。比较分层斑块组和非分层斑块组血清NPAR水平,采用多因素Logistic回归分析法分析冠状动脉分层斑块的影响因素。 [结果]与非分层斑块组比较,分层斑块组的饮酒史、管腔狭窄率、中性粒细胞百分比水平、NPAR水平高于非分层斑块组,白蛋白水平低于非分层斑块组,差异均有统计学意义(P＜0.05)。OCT特性比较,分层斑块组脂质弧更大、纤维帽厚度更薄、巨噬细胞浸润率更高、易损斑块、斑块破裂、胆固醇结晶、滋养血管、血栓、钙化小结、钙化斑块检出率更高,纤维斑块检出率更低,差异均有统计学意义(P＜0.05)。Spearman相关分析显示,血清NPAR与斑块破裂、薄纤维帽粥样斑块(TCFA)表现为正相关(r＝0.436、r＝0.622,均P＜0.05)。多因素Logistic回归分析显示,高水平的NPAR是ACS患者罪犯血管发生分层斑块的独立危险因素(OR＝10.186,95%CI:3.242～31.999,P＜0.001)。 [结论]分层斑块与斑块不稳定特性相关,血清NPAR水平在ACS罪犯血管分层斑块患者中升高,是ACS患者冠状动脉分层斑块的独立危险因素。     

Impact of metabolic syndrome on coronary plaque vulnerability in Japanese women with acute coronary syndrome.

BACKGROUND: Previous study has demonstrated that metabolic syndrome (MetS) can predict cardiovascular mortality in men, but the prediction was weak for women. In the present study predictors for multiple complex coronary lesions were investigated to clarify the impact of MetS in Japanese women with acute coronary syndrome (ACS). METHODS AND RESULTS: Subjects were Japanese women with ACS (n=81) who underwent emergency coronary angiography and B-mode carotid ultrasonography. They were divided into 2 groups based on the number of complex plaques. Although the MetS prevalence identified using the Japanese criteria was similar between the 2 groups, using the modified ATP III criteria it was more in patients with multiple coronary lesions than in those with a single coronary lesion (p<0.02). The prevalence of diabetes mellitus (DM) in the multiple group was higher than that in the single group (p<0.008). Significant independent predictors for multiple complex coronary lesions were DM (odds ratio (OR) 4.78, p<0.03) and carotid artery remodeling (OR 8.81, p<0.02). Among the components of MetS, a low level of high-density lipoprotein-cholesterol (<50 mg/dl) was a significant independent predictor (p<0.007). CONCLUSIONS: DM and carotid artery remodeling are useful markers for coronary vulnerability in Japanese women. Gender-specific pathophysiological differences may exist for components of MetS.     

Serum tenascin-C level is associated with coronary plaque rupture in patients with acute coronary syndrome

Tenascin-C, a large oligometric glycoprotein of the extracellular matrix, increases the expression of matrix metalloproteinases that lead to plaque instability and rupture, resulting in acute coronary syndrome (ACS). We hypothesized that a high serum tenascin-C level is associated with plaque rupture in patients with ACS. Fifty-two consecutive ACS patients who underwent emergency percutaneous coronary intervention (PCI) and, as a control, 66 consecutive patients with stable angina pectoris (SAP) were enrolled in this study. Blood samples were obtained from the ascending aorta just prior to the PCI procedures. After coronary guide-wire crossing, intravascular ultrasonography (IVUS) was performed for assessment of plaque characterization. Based on the IVUS findings, ACS patients were assigned to two groups according to whether there was ruptured plaque (ruptured ACS group) or not (nonruptured ACS group). There were 23 patients in the ruptured group and 29 patients in the nonruptured group. Clinical characteristics and IVUS measurements did not differ between the two groups. Tenascin-C levels were significantly higher in the ruptured ACS group than in the SAP group, whereas there was no significant difference between the nonruptured ACS and SAP groups. Importantly, in the ruptured ACS group, tenascin-C levels were significantly higher than in the nonruptured ACS group (71.9 ± 34.9 vs 50.5 ± 20.5 ng/ml, P < 0.005). Our data demonstrate that tenascin-C level is associated with pathologic conditions in ACS, especially the presence of ruptured plaque.     

急性冠状动脉综合征患者孤立性和弥漫性斑块的临床研究

目的探讨急性冠状动脉综合征患者冠状动脉孤立性病变和弥漫性病变的不同临床特征。方法从1900例冠状动脉CT检查中连续选择明确诊断急性冠状动脉综合征的患者95例,根据CT结果将患者冠状动脉病变分为孤立性病变(孤立组,61例)和弥漫性病变(弥漫组,34例),比较2组临床特征、CT积分和预后情况。结果与孤立组比较,弥漫组患者年龄更大,高血压、糖尿病、外周血管病、陈旧性心肌梗死、心功能不全的比例更高(P0.05,P0.01);弥漫组患者冠状动脉狭窄积分、病变节段积分、3支病变积分、左主干病变积分、钙化积分均明显增高(P0.05,P0.01)。随访期间,弥漫组患者心血管事件发生率明显高于孤立组(P0.05)。结论以孤立性病变和弥漫性病变区分急性冠状动脉综合征患者可作为临床判定病情和评估治疗效果的参考。     

非糖尿病急性冠状动脉综合征与急性高血糖的关系

目的:分析冠状动脉的病变程度与应激性高血糖水平的关系.方法:选择126例接受冠状动脉造影的非糖尿病急性冠状动脉综合征住院患者并监测其入院后24 h内血糖水平.根据冠状动脉病变的程度分为单支病变组、双支病变组和多支病变组.结果:多支病变组入院24 h内血糖值显著高于双支病变组[(9.9±1.0 )mmol/L∶(7.6±1.3 )mmol/L]及单支病变组[(9.9±1.0) mmol/L∶(5.9±0.4 )mmol/L],均P＜0.01.双支病变组入院24 h内血糖值同样显著高于单支病变组[(7.6±1.3) mmol/L∶(5.9±0.4 )mmol/L),P＜0.01.结论:在非糖尿病急性冠状动脉综合征患者中,急性期血糖值在一定程度与冠状动脉病变程度相关.     

The achievement of target cholesterol level differs between coronary heart disease and diabetic patients

Background

Guidelines recommend that LDL-C level should be < 100 mg/dl among diabetes mellitus (DM) and coronary heart disease (CHD) patients.

Objective

To evaluate how patients with DM and CHD differ in attaining the target level and to examine the association between goal achievement, demographic and clinical parameters.

Methods

The study was conducted in Maccabi Healthcare Services, the second largest health maintenance organization in Israel. All patients with DM (n = 54,261), CHD (n = 24,083) or DM and CHD (n = 15,370) who were listed in the computerized database and had at least one LDL-C level measurement between January 1, 2007 and July 15, 2008 were eligible. The percentage of patients who attained LDL-C level < 100 mg/dl and its association with demographic and clinical parameters were analyzed.

Results

The rate of reaching the LDL-C target level was higher among the CHD and CHD and DM patients than DM ones (67% vs. 57% vs. 50%, p < 0.001, respectively). Male gender; 5th socioeconomic status quintile; underlying disease i.e. CHD, CHD and DM; high statins compliance; and revascularization by percutaneous coronary intervention predicted for reaching target level. DM; absence of renal function evaluation; hospitalizations; HbA1C > 7% or missing its measurements had a negative predictive value.

Conclusions

The rate of reaching LDL-C target level should be increased in all high risk patients, mainly diabetic ones. Efforts should include educational programs to physicians and patients regarding the importance, the need to adhere and to intensify the cholesterol lowering treatment.