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目的用血管内超声(IVUS)对比研究不同类型冠心病患者的冠状动脉重构(remodeling)特点,探讨冠状动脉重构与临床表现、基质金属蛋白酶(MMPs)及高敏C反应蛋白(hs CRP)的关系。方法在行冠状动脉介入治疗前,应用IVUS研究38例急性冠状动脉综合征(ACS)和18例稳定性心绞痛(SA)患者,测量“罪犯”血管病变处及其近端、远端参考段的外弹力膜(EEM)面积、管腔面积,计算斑块面积和重构指数(RI),定义RI>1.05为正重构,RI<0.95为负重构。识别出高危斑块,检测外周血基质金属蛋白酶2(MMP2)、基质金属蛋白酶9(MMP9)和hs CRP水平。结果ACS组“罪犯”血管处的斑块面积大于SA组[(11.94±4.90)mm2比(9.17±3.36)mm2,P=0.035]。ACS组RI明显大于SA组(0.972±0.222比0.796±0.130,P=0.003)。两组正、负重构分布比率显著不同正重构在ACS组比SA组更常见(34.2%比5.6%,P=0.047),而负重构在SA组更常见(负重构在ACS组和SA组分别为52.6%与88.9%,P=0.003)。ACS组高危斑块发生率多于SA组(76.3%比50.0%,P=0.040)。ACS组患者血清MMP2高于SA组[(250.65±47.97)μg/L比(214.21±47.20)μg/L,P=0.029],前者的血浆MMP9也高于后者[(84.26±9.78)μg/L比(68.46±22.82)μg/L,P=0.038],前者的血清hs CRP亦高于后者[(3.62±3.37)mg/L比(1.48±1.52)mg/L
Objective To compare the characteristics of remodeling of coronary artery in patients with different types of coronary heart disease (CHD) by intravascular ultrasound (IVUS) and to explore the relationship between coronary remodeling and clinical manifestations, matrix metalloproteinases (MMPs) and high sensitivity C-reactive protein relationship. Methods Before coronary intervention, 38 patients with acute coronary syndrome (ACS) and 18 patients with stable angina pectoris (SA) were studied by IVUS, and the relationship between “criminal” vascular lesions and their proximal and distal reference segments External elastic membrane (EEM) area, luminal area, plaque area and reconstruction index (RI) were calculated. RI> 1.05 was defined as positive and RI <0.95 was negative. High-risk plaques were identified, and the levels of MMP2, MMP9 and hs CRP in peripheral blood were detected. Results The plaque area of “criminals” blood vessels in ACS group was larger than that in SA group [(11.94 ± 4.90) mm2 vs (9.17 ± 3.36) mm2, P = 0.035]. The RI of ACS group was significantly higher than that of SA group (0.972 ± 0.222 vs 0.796 ± 0.130, P = 0.003). The positive and negative remodeling distributions were significantly different in both groups. Positive remodeling was more common in the ACS group than in the SA group (34.2% vs. 5.6%, P = 0.047), whereas negative remodeling was more common in the SA group (negative remodeling in the ACS group And SA group were 52.6% and 88.9%, respectively, P = 0.003). The incidence of high-risk plaque in ACS group was higher than that in SA group (76.3% vs. 50.0%, P = 0.040). The serum MMP2 level of ACS patients was significantly higher than that of SA patients [(250.65 ± 47.97) μg / L vs 214.21 ± 47.20 μg / L, P = 0.029] L (68.46 ± 22.82) μg / L, P = 0.038]. The serum hs CRP of the former was also higher than that of the latter [(3.62 ± 3.37) mg / L vs 1.48 ± 1.52 mg / L