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目的探讨急性冠状动脉综合征(ACS)患者血管因子与冠状动脉斑块特征的相关性。方法选择56例 ACS 患者,年龄(60±11)岁,男37例,女19例,发病时取血,应用液相蛋白芯片结合流式细胞分析方法测定7种血管因子:可溶的 P 选择素(sPE)、组织血纤维蛋白溶酶原激活物(tPA)、单核细胞趋化蛋白1(MCP-1)、白细胞介素(IL)-8、IL-6、可溶的血管细胞间黏附分子1(sVCAM-1)和可溶的黏附分子40配体(sCD40L),以及相应的炎症因子;常规冠状动脉造影,并用血管内超声(IVUS)检测56个靶病变处动脉粥样斑块形态学及性质特征。分析急性心肌梗死(AMI)与不稳定性心绞痛(UA)患者、易损斑块与非易损斑块组发生斑块破裂时的血管因子改变以及斑块形态学指标与血管因子的相关性。结果存在密切相关的血管因子有 sVCAM-1和 sPE、sVCAM-1和sCD40L、sCD40L 和 sPE、IL-6和 IL-8、IL-8和 MCP1、以及 MCP1和 sVCAM-1;易损斑块组的高敏 C 反应蛋白(hs-CRP)为(18.9±4.9)mg/L,IL-5为[19.5 ng/L(9.2～44.6 ng/L)],明显高于非易损斑块组[hs-CRP:(5.8±3.6)mg/L,IL-6:5.3 ng/L(2.3～13.4 ng/L),均 P<0.05];与非斑块破裂组比较,斑块破裂组的 sCD40L[(474±126)ng/L 比(238±35)ng/L],sPE[(107.2±39.9)ng/L 比(49.1±5.6)μg/L]和 MCP-1[(132±18)ng/L 比(127±13)ng/L]明显升高(均 P<0.05);tPA 与斑块形态之间存在一定的相关性(均 P<0.05)。sCD40L、MCP-1,sPE 和 TC 水平升高是发生斑块破裂的独立危险因素(均 P<0.05)。结论炎症反应作为中间过程,IL-6和 CRP 标志易损斑块的生物特点,对AMI 可能有一定的诊断意义,而 sCD40L、MCP-1和 sPE 可能是另一个潜在的反映 ACS 严重发作的标志。
Objective To investigate the correlation between vascular factors and coronary plaque characteristics in patients with acute coronary syndrome (ACS). Methods Fifty-six ACS patients aged 60 ± 11 years, including 37 males and 19 females, were enrolled in this study. Blood samples were taken during the onset of the disease. Seven kinds of vascular factors were determined by flow cytometry (FCM): soluble P-selectin (SPE), tissue plasminogen activator (tPA), monocyte chemoattractant protein 1 (MCP-1), interleukin (IL) -8, IL-6 and soluble vascular cells (SVCAM-1), sCD40L (soluble adhesion molecule 40 ligand), and corresponding inflammatory cytokines were detected by routine coronary angiography. A total of 56 target lesions were detected by intravascular ultrasound (IVUS) Morphology and characteristics of nature. To analyze the changes of vascular factors in plaque rupture and the correlation between plaque morphology and vascular factors in patients with acute myocardial infarction (AMI) and unstable angina pectoris (UA). Results There were closely related vascular factors sVCAM-1 and sPE, sVCAM-1 and sCD40L, sCD40L and sPE, IL-6 and IL-8, IL-8 and MCP1, and MCP1 and sVCAM-1; vulnerable plaque group Hs-CRP was (18.9 ± 4.9) mg / L and IL-5 was 19.5 ng / L (9.2 ~ 44.6 ng / L)], which was significantly higher than that of non-vulnerable plaque group (5.8 ± 3.6) mg / L and IL-6: 5.3 ~ 13.4 ng / L, all P <0.05]. Compared with non-plaque rupture group, sCD40L [ (474 ± 126) ng / L vs 238 ± 35 ng / L], sPE [(107.2 ± 39.9) ng / L vs 49.1 ± 5.6 μg / L] / L ratio (127 ± 13) ng / L] (all P <0.05). There was a correlation between tPA and plaque morphology (all P <0.05). The levels of sCD40L, MCP-1, sPE and TC were independent risk factors of plaque rupture (all P <0.05). Conclusions Inflammatory reaction is an intermediate process. The biological characteristics of vulnerable plaque with IL-6 and CRP markers may have some diagnostic significance for AMI. However, sCD40L, MCP-1 and sPE may be other potential markers reflecting the severity of ACS .