冠心病与颈动脉斑块及丙二醛化低密度脂蛋白的相关性研究

目的研究冠心病患者冠心病与颈动脉内-中膜厚度(CCA-IMT)、斑块指数及丙二醛化低密度脂蛋白(MDA-LDL)的相关性。方法收集冠状动脉造影的冠心病患者82例,根据斑块形态,冠心病患者分为3组,即Ⅰ型病变(表面光滑)组(n=31),Ⅱ型病变(表面不规则)组(n=a2)及Ⅲ型病变(长段不规则)组(n=19),冠状动脉造影正常的25例为对照组纳入研究。采用高频超声探测各组双侧颈动脉 IMT 和软斑指数,硬斑指数及总斑块指数,以及测定血浆 MDA-LDL 含量。结果 (1)冠心病各组(包括Ⅰ型、Ⅱ型、Ⅲ型病变组)CCA-IMT、软斑 PI、硬斑PI、总斑 PI 与对照组相比明显增高(均P<0.01);冠心病Ⅱ型病变组软斑 PI、总斑 PI 与Ⅰ型、Ⅲ型病变组相比明显增高(P<0.01);Ⅱ型病变组血浆 MDA-LDL 含量与Ⅰ型、Ⅲ型病变组及照组相比明显增高(P<0.01)。(2)Ⅱ型病变组 MDA-LDL 含量与软斑 PI、总斑 PI 呈正相关(r=0.63,P<0.01;r=0.51,P<0.05)。结论通过颈动脉超声检测,颈动脉斑块(特别是软斑)的检出,结合血浆 MDA-LDL 含量,可以初步预测冠心病患者冠状动脉斑块的不稳定。

Relation of angiographic type Ⅱ lesion to ultrasonographic carotid atherosclerotic plaque and MDA-LDL in patients with coronary heart disease

Objective To evaluate the relation of angiographic type Ⅱ lesion(representing unstable or ruptured plaque,with or without thrombosis)to ultrasonographic intima-media thickness(IMT),atherosclerotic plaque indices and plasma malondialdehyde-modified low density lipoprotein(MDA-LDL)level in patients with coronary heart disease(CHD).Methods One hundred and seven patients who underwent coronary angiography were divided into two groups:CHD group(82 cases)and normal control group(25 cases).The angiographic morphology of plaques was analyzed.According to the morphologic types of plaque,patients with CHD were divided into type Ⅰ(smooth borders)group(n=31),type Ⅱ(irregular lesions)group(n=32) and type Ⅲ(long lesions)group (n=19).Carotid IMT and plaque indices were assessed by high frequency ultrasonography and plasma MDA-LDL levels were measured.Results (1)Compared with normal control group,common carotid artery(CCA)-IMT, soft and hard plaque indices,total plaque index in CHD patients(including type Ⅰ,Ⅱ,Ⅲ groups)were significantly increased(P<0.01,respectively).Soft plaque indices and total plaque index in type Ⅱ group were significantly higher than in type Ⅰ group and in type Ⅲ group.The plasma MDA-LDL level was significantly elevated in type Ⅱ group than in normal control group,type Ⅰ group,and type Ⅲ group(P<0.01,respectively). (3)In type Ⅱ group,plasma MDA-LDL level was significantly positive correlated with soft plaque indices and total plaque index(r=0.63,P<0.01;r=0.51,P<0.05 respectively).Conclusions Angiographie morphology of the coronary artery lesion in CHD patients can be predicted by combination of ultrasonographic carotid soft plaque indices and plasma MDA-LDL level.