冠状动脉斑块显像特征与妊娠相关血浆蛋白A水平的关系

目的探讨老年冠心病患者血管内超声冠状动脉斑块显像特征与妊娠相关血浆蛋白A水平的关系。方法选择冠心病患者100例,其中急性冠状动脉综合征组50例,稳定性心绞痛组50例,另选除外冠心病的对照组50例,所有患者行冠状动脉造影术检查,术前1h检测妊娠相关血浆蛋白A水平,应用血管内超声比较急性冠状动脉综合征组和稳定性心绞痛组冠状动脉斑块显像特征及测量参数,比较3组患者妊娠相关血浆蛋白A水平。结果急性冠状动脉综合征组妊娠相关血浆蛋白A水平显著高于稳定性心绞痛组及对照组(34.08±10.57)mU/L vs(11.38±8.56)mU/L,(9.50±6.24)mU/L,P<0.01];急性冠状动脉综合征组冠状动脉斑块纤维帽厚度、管腔面积明显小于稳定性心绞痛组(P<0.05),斑块面积、斑块负荷、偏心指数及重构指数明显大于稳定性心绞痛组(P<0.01)。妊娠相关血浆蛋白A水平与偏心指数、重构指数呈正相关(r=0.355,r=0.297,P<0.05),与纤维帽厚度呈负相关(r=-0.367,P<0.01)。结论妊娠相关血浆蛋白A水平与血管内超声的斑块易损性指标存在相关性,妊娠相关血浆蛋白A可作为评价冠状动脉斑块稳定性一个炎性指标。

Relation between imaging features of coronary atherosclerotic plaques and pregnancy-associated plasma protein-A level

Objective To study the relation between imaging features of coronary atherosclerotic plaques and pregnancy-associated plasma protein-A(PAPP-A)level in elderly CHD patients.Methods One hundred elderly CHD patients admitted to our hospital were divided into ACS group(n=50)and stable angina pectoris(SAP)group(n=50),and 50non-CHD subjects served as a control group.The patients underwent coronary angiography(CAG).Their serum PAPP-A level was measured at 1hbefore operation.Imaging features and plasma PAPP-A level were compared between ACS group and SAP group,and relation between PAPP-A level and IVUS-detected parameters of stable coronary atherosclerotic plaques were compared in 3groups.Results The plasma PAPP-A level was significantly higher in ACS group than in SAP group and control group(34.08±10.57mU/Lvs 11.38±8.56mU/L,9.50±6.24mU/L,P<0.01).The coronary atherosclerotic plaque fibrous cap was thinner and the lumen area was smaller while the the plaque area was significantly larger and the plaque burden,eccentricity index,remodeling index were significantly higher in ACS group than in SAP group(P<0.05,P<0.01).The plasma PAPP-A level was popsitively related with the eccentricity index and remodeling index(r=0.355,r=0.297,P<0.05)and negatively related with the fibrous cap thickness(r=-0.367,P<0.01).ConclusionPlasma PAPP-A level is related with vulnerable coronary atherosclerotic plaques and can thus be used as an inflammation index in assessment of their stability.