【摘要】：[目的]本研究擬評估急性冠脈綜合征(ACS)患者血清標(biāo)記物(hsCRP,MIF,CXCL12、WISP-1、Galectin-3)的水平,分析ACS犯罪血管易損斑塊的雙源螺旋CT(DSCT)形態(tài)學(xué)特征,及其二者的關(guān)聯(lián)性分析,從而在血清學(xué)和形態(tài)學(xué)兩方面評價ACS患者冠狀動脈的斑塊特點。[方法]入選2012年7月一 2016年3月因胸痛在北京協(xié)和醫(yī)院心內(nèi)科住院行冠脈造影的冠心病患者149例,且在冠脈造影前30天內(nèi)均行DSCT檢查。入選同期75例年齡、性別及BMI相匹配的冠脈造影大致正常的非冠心病者作為對照組。研究對象根據(jù)臨床表現(xiàn)及輔助檢查分為三組,包括急性冠脈綜合征組92例,穩(wěn)定型心絞痛組57例,對照組75例。分別測定hsCRP,MIF,CXCL12、WISP-1 及Galectin-3(GLA3)的血清水平,分析ACS其犯罪血管及穩(wěn)定型心絞痛患者其靶血管斑塊的DSCT特點,包括管腔狹窄程度、斑塊成分、鈣化面積、重構(gòu)指數(shù),并分析血清生物標(biāo)記物與DSCT評價冠狀動脈斑塊性質(zhì)的相關(guān)性。[結(jié)果]1、ACS組與對照組相比,血清hsCRP水平顯著增高(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)水平顯著降低,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)但無統(tǒng)計學(xué)差異;SAP組較對照組相比,血清CXCL12水平降低,有統(tǒng)計學(xué)趨勢(p=0.058),而hsCRP、WISP1、GLA3無統(tǒng)計學(xué)差異;ACS組較SAP組相比,hsCRP水平更高、WISPI水平更低。2、在ACS、SAP患者及非冠心病人群中,控制年齡、性別、血脂水平及冠心病危險因素后,血清CXCL12與WISP1及GLA3水平呈正相關(guān)。3、ACS組較SAP組對比,纖維性斑塊、點狀鈣化、正性重構(gòu)發(fā)生率更高,但無顯著性差異。4、血清hsCRP水平在ACS非鈣化斑塊組明顯高于SAP鈣化斑塊組,在ACS非大鈣化斑塊組明顯高于SAP大鈣化斑塊組。但MIF、CXCL12、WISP1、GLA3在DSCT斑塊類型亞組間比較無統(tǒng)計學(xué)差異。5、logistic回歸分析表明,hsCRP與ACS、CAD的發(fā)生有關(guān),且為危險因素。[結(jié)論]1、血清hsCRP水平的增高、WISP1及GLA3水平的降低與ACS相關(guān)。血清CXCL12可能具有抗動脈粥樣硬化的作用,但不能很好反映斑塊的穩(wěn)定性。2、低密度斑塊、點狀鈣化、正性重構(gòu)可能是ACS易損斑塊的形態(tài)學(xué)特征。3、血清hsCRP聯(lián)合DSCT可能與冠狀動脈易損斑塊相關(guān),較其他標(biāo)記物能更好的評估冠狀動脈斑塊的性質(zhì)。
[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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4;R816.2

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