冠状动脉斑块超声影像学特征与血浆内皮素及一氧化氮的相关研究

目的探讨冠心病患者冠状动脉斑块超声影像学特征及其与血浆内皮素(ET)、一氧化氮(NO)的关系。方法44例冠心病患者分为不稳定型和稳定型心绞痛组,比较两组患者靶血管内超声特征及血浆ET和NO水平,进行相关研究。结果不稳定型心绞痛组血管内超声检出脂质斑块23例(23/28,82.1%),其罪犯病变的血管外弹力膜面积(EEMA)、斑块面积(PA)及管腔面积狭窄率(LAS)、重构指数(RI)明显大于稳定型心绞痛组,差异有显著性意义(均P<0.05)。两组间在纤维帽厚度、脂核或无回声带大小、脂核与斑块比之间存在统计学差异。血浆ET1与EEMA、RI呈正相关,NO与EEMA、RI呈负相关。结论易损斑块为偏心分布的低回声脂质斑块,具有较大的斑块面积和明显的正性重构;血浆ET1、NO参与了粥样硬化的形成,ET1、NO可望作为冠脉斑块易损性预测的参考指标。

Correlation study between intravascular ultrasound features of atherosclerotic plaques and endothelin,nitric oxide

Objective To assess relationship between intravascular ultrasound(IVUS) features of coronary atherosclerotic plaques and endothelin(ET),nitric oxide(NO) in patients with angina pectoris.Methods Forty-four patients with angina pectoris were divided into unstable angina group and stable angina group.ET and NO were measured and compared between two groups,and IVUS was used to analysis their coronary lesions.The results were analyzed by correlate analysis.Results IVUS found that 82.1%(23/28) patients in unstable angina group had soft lipid plaques.External elastic membrane area(EEMA),plaque area(PA),area stenosis ratio(LAS) and remodeling index(RI) in unstable angina group were larger than those in stable angina group( P < 0.05,respectively).There was significant difference in the thickness of fibrous cap,the lipid core areas and lipid to plaque ratio between unstable angina and stable angina group.ET-1 in plasma was positively correlated with EEMA,RI,while NO was negatively correlated with EEMA,RI.Conclusions Vulnerable atherosclerotic plaques are eccentric,soft lipid plaques,with large plaque areas and the vessel at the lesion shows positive remodeling.It has been documented that an elevated ET-1 and low NO in plasma are associated with coronary atherosclerotic plaque vulnerability,which confirms the role of ET-1 and NO in the pathogenesis of CAD.ET-1 and NO could be used as reference indices for the identification of plaque vulnerability.