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目的探讨冠状动脉(冠脉)粥样斑块稳定性和炎症反应在急性冠状动脉综合征(ACS)中的作用。方法对28例ACS和13例稳定性心绞痛(SA)患者“罪犯”冠脉进行血管内超声(IVUS)检查,同时测定外周血清高敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)、组织型基质金属蛋白酶抑制剂-1(TIMP-1)、可溶性CD40L(sCD40L)含量。结果ACS患者冠脉病变处以软斑块为主71.4%(20/28),SA患者冠脉病变处以硬斑块为主76.9%(10/13),差异有统计学意义(P=0.004)。与SA组比较,ACS组病变处斑块面积大(P=0.004)、斑块负荷重(P=0.048)、以正性重构为主(P=0.013)。ACS组血清hs-CRP、MMP-9、sCD40L含量均高于SA组,TIMP-1含量在ACS组和SA组之间差异无统计学意义(P=0.234),ACS组hs-CRP与MMP-9(r=0.671,P=0.000)、sCD40L(r=0.494,P=0.008)呈正相关。结论冠脉“罪犯”病变处结构性易损斑块是ACS发作基础,CD40L和MMP-9参与的炎症反应导致斑块功能性不稳定和不同临床表现。
Objective To investigate the role of coronary artery (coronary) atherosclerotic plaque stability and inflammation in acute coronary syndrome (ACS). Methods The “culprit” coronary arteries of 28 patients with ACS and 13 patients with stable angina pectoris (SAUS) were examined by intravascular ultrasound (IVUS) and serum hs-CRP, MMP-9 -9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and soluble CD40L (sCD40L). Results The lesions of coronary artery in ACS patients were predominantly soft lesions (71.4%, 20/28), and the lesions of SA patients were mainly composed of hard plaques (76.9%, 10/13). The difference was statistically significant (P = 0.004). Compared with SA group, plaque area was larger in ACS group (P = 0.004) and plaque burden (P = 0.048), with positive remodeling (P = 0.013). The levels of serum hs-CRP, MMP-9 and sCD40L in ACS group were higher than those in SA group. There was no significant difference in TIMP-1 content between ACS group and SA group (P = 0.234) 9 (r = 0.671, P = 0.000), sCD40L (r = 0.494, P = 0.008). CONCLUSIONS: Structural vulnerable plaques in the “criminal” lesions of the coronary artery are the basis of ACS attack. Inflammatory reactions involving CD40L and MMP-9 lead to functional instability and clinical manifestations of plaques.