血清标记物联合双源螺旋CT评价冠脉动脉斑块性质的研究
发布时间：2018-11-09 18:18
【摘要】：[目的]本研究拟评估急性冠脉综合征(ACS)患者血清标记物(hsCRP,MIF,CXCL12、WISP-1、Galectin-3)的水平,分析ACS犯罪血管易损斑块的双源螺旋CT(DSCT)形态学特征,及其二者的关联性分析,从而在血清学和形态学两方面评价ACS患者冠状动脉的斑块特点。[方法]入选2012年7月一 2016年3月因胸痛在北京协和医院心内科住院行冠脉造影的冠心病患者149例,且在冠脉造影前30天内均行DSCT检查。入选同期75例年龄、性别及BMI相匹配的冠脉造影大致正常的非冠心病者作为对照组。研究对象根据临床表现及辅助检查分为三组,包括急性冠脉综合征组92例,稳定型心绞痛组57例,对照组75例。分别测定hsCRP,MIF,CXCL12、WISP-1 及Galectin-3(GLA3)的血清水平,分析ACS其犯罪血管及稳定型心绞痛患者其靶血管斑块的DSCT特点,包括管腔狭窄程度、斑块成分、钙化面积、重构指数,并分析血清生物标记物与DSCT评价冠状动脉斑块性质的相关性。[结果]1、ACS组与对照组相比,血清hsCRP水平显著增高(1.84mg/L,interquartile range[IQR]0.79-4.84 mg/L vs 0.84mg/L,IQR 0.46-1.91mg/L,P=0.001),CXCL12(0.33ng/ml,IQR 0.14-0.48ng/ml vs 0.36ng/ml,IQR 0.27-0.50ng/ml,p=0.037)、WISPl(1.62ng/ml,IQR 1.50-1.73ng/ml vs 1.70 ng/ml,IQR 1.58-1.77ng/ml,p=0.021)、GLA3(0.83ng/ml,IQR 0.43-1.04ng/ml vs 0.96ng/ml,IQR 0.70-1.17ng/ml,p=0.032)水平显著降低,MIF 水平增高(0.45 ng/ml,IQR 0.28-0.67ng/ml vs 0.38ng/ml,IQR 0.23-0.74ng/ml,p =0.419)但无统计学差异;SAP组较对照组相比,血清CXCL12水平降低,有统计学趋势(p=0.058),而hsCRP、WISP1、GLA3无统计学差异;ACS组较SAP组相比,hsCRP水平更高、WISPI水平更低。2、在ACS、SAP患者及非冠心病人群中,控制年龄、性别、血脂水平及冠心病危险因素后,血清CXCL12与WISP1及GLA3水平呈正相关。3、ACS组较SAP组对比,纤维性斑块、点状钙化、正性重构发生率更高,但无显著性差异。4、血清hsCRP水平在ACS非钙化斑块组明显高于SAP钙化斑块组,在ACS非大钙化斑块组明显高于SAP大钙化斑块组。但MIF、CXCL12、WISP1、GLA3在DSCT斑块类型亚组间比较无统计学差异。5、logistic回归分析表明,hsCRP与ACS、CAD的发生有关,且为危险因素。[结论]1、血清hsCRP水平的增高、WISP1及GLA3水平的降低与ACS相关。血清CXCL12可能具有抗动脉粥样硬化的作用,但不能很好反映斑块的稳定性。2、低密度斑块、点状钙化、正性重构可能是ACS易损斑块的形态学特征。3、血清hsCRP联合DSCT可能与冠状动脉易损斑块相关,较其他标记物能更好的评估冠状动脉斑块的性质。
[Abstract]:[objective] to evaluate the level of serum marker (hsCRP,MIF,CXCL12,WISP-1,Galectin-3) in patients with acute coronary syndrome (ACS) and to analyze the morphological features of double helix CT (DSCT) in the vulnerable plaque of ACS. To evaluate the plaque characteristics of coronary artery in ACS patients in both serological and morphological aspects. [methods] 149 patients with coronary artery disease underwent coronary angiography in Department of Cardiology, Peking Union Hospital for chest pain from July 2012 to March 2016. DSCT examination was performed within 30 days before coronary angiography. Seventy-five patients with age, sex and BMI matched coronary angiography were selected as control group. Participants were divided into three groups according to their clinical manifestations and adjuvant examinations, including 92 cases of acute coronary syndrome group, 57 cases of stable angina pectoris group and 75 cases of control group. The serum levels of hsCRP,MIF,CXCL12,WISP-1 and Galectin-3 (GLA3) were measured, and the DSCT characteristics of target vascular plaques in patients with ACS and stable angina pectoris were analyzed, including the degree of stenosis of lumen, the composition of plaque, the area of calcification. The relationship between serum biomarkers and DSCT in evaluating coronary plaque was analyzed. [results] 1Serum hsCRP levels in the ACS group were significantly higher than those in the control group (1.84 mg / L interquartile range [IQR] 0.79-4.84 mg/L vs 0.84mg / L IQR 0.46-1.91 mg / L P0 001), CXCL12 (0.33 ng / ml). IQR 0.14-0.48ng/ml vs 0.36ng / ml IQR 0.27-0.50ng / ml 0.037), WISPl (1.62ng / ml / ml 1.70 ng/ml,IQR 1.58-1.77ng / ml / ml 0.021), GLA3 (0.83ng / ml) IQR 0.43-1.04ng/ml vs 0.96ng / ml 0.96ng / ml IQR 0.70-1.17ng / ml 0.032 decreased significantly, and MIF level increased (0.45 ng/ml,IQR 0.28-0.67ng/ml vs 0.38ng / ml). IQR 0.23-0.74 ng 路ml ~ (-1) p = 0.419), but there was no statistical difference. Compared with the control group, the serum CXCL12 level in the SAP group was significantly lower than that in the control group (p0. 058), but there was no statistical difference in hsCRP,WISP1,GLA3. Compared with SAP group, hsCRP level was higher and WISPI level was lower in ACS group than in SAP group. After controlling age, sex, blood lipid level and risk factors of coronary heart disease, serum CXCL12 was positively correlated with WISP1 and GLA3 levels in ACS,SAP patients and non-coronary heart disease patients. The incidence of fibrous plaque, punctate calcification and positive remodeling in ACS group was higher than that in SAP group, but there was no significant difference. 4. The serum hsCRP level in ACS non-calcified plaque group was significantly higher than that in SAP calcified plaque group. No calcification plaques in ACS group were significantly higher than those in SAP large calcified plaque group. However, there was no significant difference in MIF,CXCL12,WISP1,GLA3 between subgroups of DSCT plaque type. 5. Logistic regression analysis showed that hsCRP was associated with the occurrence of ACS,CAD and was a risk factor. [conclusion] 1. The increase of serum hsCRP level and the decrease of WISP1 and GLA3 levels are related to ACS. Serum CXCL12 may have anti-atherosclerosis effect, but it can not well reflect the stability of plaque. 2. Low density plaque, punctate calcification, positive remodeling may be the morphological characteristics of ACS vulnerable plaque. Serum hsCRP combined with DSCT may be associated with coronary plaque vulnerability, compared with other markers can better assess the nature of coronary plaque.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2
本文编号：2321193
[Abstract]:[objective] to evaluate the level of serum marker (hsCRP,MIF,CXCL12,WISP-1,Galectin-3) in patients with acute coronary syndrome (ACS) and to analyze the morphological features of double helix CT (DSCT) in the vulnerable plaque of ACS. To evaluate the plaque characteristics of coronary artery in ACS patients in both serological and morphological aspects. [methods] 149 patients with coronary artery disease underwent coronary angiography in Department of Cardiology, Peking Union Hospital for chest pain from July 2012 to March 2016. DSCT examination was performed within 30 days before coronary angiography. Seventy-five patients with age, sex and BMI matched coronary angiography were selected as control group. Participants were divided into three groups according to their clinical manifestations and adjuvant examinations, including 92 cases of acute coronary syndrome group, 57 cases of stable angina pectoris group and 75 cases of control group. The serum levels of hsCRP,MIF,CXCL12,WISP-1 and Galectin-3 (GLA3) were measured, and the DSCT characteristics of target vascular plaques in patients with ACS and stable angina pectoris were analyzed, including the degree of stenosis of lumen, the composition of plaque, the area of calcification. The relationship between serum biomarkers and DSCT in evaluating coronary plaque was analyzed. [results] 1Serum hsCRP levels in the ACS group were significantly higher than those in the control group (1.84 mg / L interquartile range [IQR] 0.79-4.84 mg/L vs 0.84mg / L IQR 0.46-1.91 mg / L P0 001), CXCL12 (0.33 ng / ml). IQR 0.14-0.48ng/ml vs 0.36ng / ml IQR 0.27-0.50ng / ml 0.037), WISPl (1.62ng / ml / ml 1.70 ng/ml,IQR 1.58-1.77ng / ml / ml 0.021), GLA3 (0.83ng / ml) IQR 0.43-1.04ng/ml vs 0.96ng / ml 0.96ng / ml IQR 0.70-1.17ng / ml 0.032 decreased significantly, and MIF level increased (0.45 ng/ml,IQR 0.28-0.67ng/ml vs 0.38ng / ml). IQR 0.23-0.74 ng 路ml ~ (-1) p = 0.419), but there was no statistical difference. Compared with the control group, the serum CXCL12 level in the SAP group was significantly lower than that in the control group (p0. 058), but there was no statistical difference in hsCRP,WISP1,GLA3. Compared with SAP group, hsCRP level was higher and WISPI level was lower in ACS group than in SAP group. After controlling age, sex, blood lipid level and risk factors of coronary heart disease, serum CXCL12 was positively correlated with WISP1 and GLA3 levels in ACS,SAP patients and non-coronary heart disease patients. The incidence of fibrous plaque, punctate calcification and positive remodeling in ACS group was higher than that in SAP group, but there was no significant difference. 4. The serum hsCRP level in ACS non-calcified plaque group was significantly higher than that in SAP calcified plaque group. No calcification plaques in ACS group were significantly higher than those in SAP large calcified plaque group. However, there was no significant difference in MIF,CXCL12,WISP1,GLA3 between subgroups of DSCT plaque type. 5. Logistic regression analysis showed that hsCRP was associated with the occurrence of ACS,CAD and was a risk factor. [conclusion] 1. The increase of serum hsCRP level and the decrease of WISP1 and GLA3 levels are related to ACS. Serum CXCL12 may have anti-atherosclerosis effect, but it can not well reflect the stability of plaque. 2. Low density plaque, punctate calcification, positive remodeling may be the morphological characteristics of ACS vulnerable plaque. Serum hsCRP combined with DSCT may be associated with coronary plaque vulnerability, compared with other markers can better assess the nature of coronary plaque.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4;R816.2
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