冠心病与颈动脉斑块及丙二醛化低密度脂蛋白的相关性研究.docVIP

冠心病与颈动脉斑块及丙二醛化低密度脂蛋白的相关性研究 　　作者：张志辉，朱文晖， 张梦玺，杨侃 作者单位：中南大学湘雅三医院， 湖南 长沙410013 　　【摘要】 目的 研究冠心病患者冠心病与颈动脉内中膜厚度(CCAIMT)、斑块指数及丙二醛化低密度脂蛋白(MDALDL)的相关性。方法 收集冠状动脉造影的冠心病患者82例，根据斑块形态，冠心病患者分为3组，即Ⅰ型病变(表面光滑)组(n=31)，Ⅱ型病变(表面不规则)组(n=32)及Ⅲ型病变(长段不规则)组(n=19)，冠状动脉造影正常的25例为对照组纳入研究。采用高频超声探测各组双侧颈动脉IMT和软斑指数,硬斑指数及总斑块指数，以及测定血浆MDALDL含量。结果 (1)冠心病各组(包括Ⅰ型、Ⅱ型、Ⅲ型病变组)CCAIMT、软斑PI、硬斑PI、总斑PI与对照组相比明显增高(均P0.01);冠心病Ⅱ型病变组软斑PI、总斑PI与Ⅰ型、Ⅲ型病变组相比明显增高(P0.01);Ⅱ型病变组血浆MDALDL含量与Ⅰ型、Ⅲ型病变组及照组相比明显增高(P0.01)。(2)Ⅱ型病变组MDALDL含量与软斑PI、总斑PI呈正相关(r=0.63,P0.01;r=0.51,P0.05)。结论 通过颈动脉超声检测,颈动脉斑块(特别是软斑)的检出，结合血浆MDALDL含量，可以初步预测冠心病患者冠状动脉斑块的不稳定。 　　【关键词】 冠心病,冠状动脉造影术,斑块形态学,颈动脉斑块,丙二醛化低密度脂蛋白 　　Abstract：Objective To evaluate the relation of angiographic type Ⅱ lesion (representing unstable or ruptured plaque, with or without thrombosis) to ultrasonographic intimamedia thickness (IMT), atherosclerotic plaque indices and plasma malondialdehydemodified low density lipoprotein(MDALDL)level in patients with coronary heart disease(CHD). Methods One hundred and seven patients who underwent coronary angiography were divided into two groups:CHD group (82 cases) and normal control group (25 cases). The angiographic morphology of plaques was analyzed. According to the morphologic types of plaque, patients with CHD were divided into type Ⅰ (smooth borders) group (n=31), type Ⅱ (irregular lesions) group (n=32) and type Ⅲ (long lesions) group (n=19). Carotid IMT and plaque indices were assessed by high frequency ultrasonography and plasma MDALDL levels were measured. Results (1) Compared with normal control group, common carotid artery(CCA)IMT, soft and hard plaque indices, total plaque index in CHD patients (including typeⅠ, Ⅱ, Ⅲ groups) were significantly increased (P0.01, respectively). Soft plaque indices and total plaque index in type Ⅱ group were significantly higher than in type Ⅰ group and in type Ⅲ group. The plasma MDALDL level was significantly elevated in type Ⅱ group than in normal control group, type Ⅰ group, and typ