CT联合IgE和同型半胱氨酸检测诊断冠脉斑块稳定性的临床价值

目的 通过对拟诊为冠心病的患者行64排螺旋CT检查，血清免疫球蛋白E (IgE)和同型半胱氨酸(Hcy)水平检测,探讨其对冠脉斑块稳定性的预测价值。 方法 选择可疑及确诊的冠心病患者83例为研究对象,所有患者均行冠脉CT和冠状动脉造影检查，冠脉CT未见粥样硬化者纳入对照组，其余患者根据病史及冠脉造影结果分为急性冠脉综合症组(acute coronary syndrome，ACS),稳定型心绞痛组(stable angina pectoris，SAP)，根据冠脉CT检查结果，再次分为易损斑块组、混合斑块组、稳定斑块组，记录研究对象的一般情况，所有患者均行血清IgE和Hcy检测。 结果 ①易损斑块在ACS组的分布高于SAP组(P＜0.05)，稳定斑块在SAP组的分布高于ACS组(P＜0.05)。②ACS组和SAP组Hcy水平均高于对照组(P＜0.05)，ACS组Hcy水平高于SAP组(P＜0.05)，ACS组、SAP组和对照组间IgE水平差异无统计学意义(P＞0.05)。③易损斑块组、混合斑块组、稳定斑块组Hcy水平均高于对照组(P＜0.05)，且易损斑块组Hcy水平＞混合斑块组＞稳定斑块组,差异均有统计学意义(P＜0.05)，各斑块组IgE水平差异无统计学意义(P＞0.05)。 结论 ①冠脉CT可较准确地显示冠脉斑块的性质。②Hcy与冠状动脉斑块不稳定性关系密切，可反应冠脉斑块的不稳定性；IgE与冠状动脉斑块的稳定性无关。③Hcy结合冠脉CT对冠脉斑块的不稳定性有预测价值。 

Clinical value of 64-Multislice spiral computed tomography combined with immunoglobulin E and homocysteinefor detecting the stability of coronary artery plaques

Objective To investigate the value of 64-MSCT combined with Ig E and Hcy for estimating the stability of coronary artery plaques of patients with coronary heart disease. Methods The 83 patients in-hospital doubtful or diagnosed coronary heart disease admitted to our hospital were enrolled. All patients conducted with CT tomography and coronary angiography(CAG),the result of CT tomography of who were negative,were divided into control group. According to the results of CAG and medical history,the others were divided into acute coronary syndrome(ACS) group,stable angina pectoris(SAP) group. According to the results of coronary artery plaques detected by MSCT,both ACS and SAP groups were further divided into vulnerable plaque group,mixed plaque group and stable plaque group. The levels of serum immunoglobulin E(Ig E) and homocysteine(Hcy) were detected. The clinical characteristics of patients were recorded. Ig E and(Hcy) were measured. Results 1The distribution of vulnerable plaques in ACS group was higher than that in SAP group(P < 0. 05),while that of stable plaques lower than in SAP group(P < 0. 05). 2The levels of homocysteine(Hcy)in SAP and ACS group were higher than those in control group(P < 0. 05),and there was significant difference between SAP and ACS groups(P < 0. 05). The levels of Ig E were not significant different between SAP and ACS groups(P >0. 05),3The levels of homocysteine(Hcy) in every plaque group were all obviously higher than those in the control group(P < 0. 05),and those in vulnerable and mixed plaque group were also higher than those in stable plaque group(P < 0. 05). The levels of homocysteine(Hcy) in vulnerable plaque group were higher than those in mixed plaque group(P < 0. 05). The levels of Ig E in every plaque group were not higher than those in the control group(P > 0. 05). Conclusion 164-MSCTcan accurately characterize the composition of the coronary artery plaques. 2The relationship between the levels of Hcy and the stability of coronary artery plaques were intimate,which can reflect the stability of coronary artery plaques,the relationship between Ig E and unstable coronary artery plaques is not notable. 3The detection of 64-MSCT combined with homocysteine(Hcy) had predictive value of unstable coronary artery plaques.