急性冠状动脉综合征颈动脉粥样斑块稳定性及相关因素分析

目的探讨急性冠状动脉综合征（acute coronary syndrome，ACS）患者颈动脉粥样斑块特征与临床相关因素的关系。方法136例ACS患者（ACS组）和123例稳定性心绞痛（stableanginapectoris，SAP）患者（SAP组），2组行超声检查颈动脉粥样硬化斑块及生化指标、冠状动脉血管狭窄程度和炎性因子等相关因素测定，根据斑块内部回声强弱不同将ACS组再分为均质斑块组和非均质斑块组；采用相关分析及logistic回归分析，分析ACS颈动脉斑块稳定性同临床相关因素间关系。结果ACS组和SAP组年龄、尿酸、炎性因子水平、三酰甘油、高密度脂蛋白胆固醇水平及非均质斑块比例比较差异有统计学意义（P〈0．05）；ACS组经年龄校正后细胞间黏附因子-1及高敏C反应蛋白水平与颈动脉粥样硬化斑块积分呈正相关（r=0．31，P=0．04；r=0．81，P=0．01），ACS患者中非均质斑块组炎性因子明显高于均质斑块组（P％0．05）；以发生ACS与否为因变量进行logistic回归分析发现除年龄外，细胞间黏附因子-1（OR：1．15，95％CI：1．02～1．65，P=0．03）和高敏C反应蛋白（OR=1．32，95％CI：1．20～1．68，P=0．04）是ACS发生的危险因素。结论炎症与颈动脉粥样硬化斑块稳定性有相关性，炎性因子是ACS发生的重要预测因素。

Stability of carotid atherosclerotic plaque in acute coronary syndrome and its related factors

Objective To explore the relationship between carotid atherosclerotic plaque and clinical related factors in patients with acute coronary syndrome （ACS）. Methods A total of 136 ACS patients and 123 stable angina pectoris （SAP） patients were measured carotid atherosclerotic plaque by ultrasonography and were detected the biochemical parameter, coronary artery stenosis degree and inflammatory factors. According to the internal density of plaque, the enrolled ACS patients were divided into homogeneous and non-homogeneous plaque groups, and were analyzed the relationship between carotid plaque stability and clinical factors by correlation analysis and logistic regression analysis. Results There were significant differences in the age, uric acid, inflammatory factor, triacylglycerol, high density lipoprotein-cholesterol and proportion of non-homogeneous plague between ACS group and SAP group （P~0.05）. After adjusting for age, the intercellular adhesion molecule-1 and high sensitivity C-reactive protein showed a positive correlation with carotid plaque score in ACS group （r=0.31, P=0.04; r=0.81, P=0.01）. In ACS patients, the concentration of inflammatory cytokines in non-homogeneous plaque group was significantly higher than that in homogeneous plaque group （P%0.05）. Logistic regression analysis showed that the intercellular adhesion molecule-1 （OR= 1.15,95 % CI： 1.02 1.65, P=0.03） and high sensitivity C-reactive protein （OR=I. 32,95%CI： 1.20-1.68, P=0.04） were independent risk factors for ACS besides the age. Conclusions There is a correlation between inflammatory factors and the stability carotid atherosclerotic plague, and the inflammatory factors are the important factors for predicting ACS.