CAJ | 학술논문

目的：观察不同类型冠心病患者血清脂蛋白（a）[Lp（a）]水平及在血管内超声（IVUS）下冠状动脉斑块显像特征关系。方法选择在我院住院急性冠状动脉综合征（ACS）患者88例，稳定型心绞痛（SAP）患者72例，同时选取在门诊因胸痛就诊，行冠状动脉造影显示正常的患者80例作为对照组，测定三组患者血清Lp（a）水平，应用IVUS评价ACS组和SAP组患者冠状动脉斑块的形态、特征及易损性。并进一步评价血清Lp（a）与IVUS评价易损性斑块指标的相关性。结果 ACS组血清Lp（a）浓度显著高于SAP组及对照组（均P＜0.01），ACS组狭窄病变处主要为软斑块、偏心性斑块，而SAP组则反之，ACS组IVUS斑块面积（P＜0.01）、偏心指数及重构指数（P均＜0.05）均大于SAP组，管腔面积小于SAP组（P＜0.01），血浆 Lp（a）水平与软斑块面积百分比、偏心指数和血管重构指数（r＝0.365，P＝0.011；r＝0.448，P＝0.008和r＝0.432， P＜0.001）呈正相关。结论 ACS组血清Lp（a）水平明显高于SAP组和对照组，血清Lp（a）水平与IVUS评价斑块易损性指标相关，Lp（a）可作为冠状动脉易损斑块的评估因子。
목적：관찰불동류형관심병환자혈청지단백（a）[Lp（a）]수평급재혈관내초성（IVUS）하관상동맥반괴현상특정관계。방법선택재아원주원급성관상동맥종합정（ACS）환자88례，은정형심교통（SAP）환자72례，동시선취재문진인흉통취진，행관상동맥조영현시정상적환자80례작위대조조，측정삼조환자혈청Lp（a）수평，응용IVUS평개ACS조화SAP조환자관상동맥반괴적형태、특정급역손성。병진일보평개혈청Lp（a）여IVUS평개역손성반괴지표적상관성。결과 ACS조혈청Lp（a）농도현저고우SAP조급대조조（균P＜0.01），ACS조협착병변처주요위연반괴、편심성반괴，이SAP조칙반지，ACS조IVUS반괴면적（P＜0.01）、편심지수급중구지수（P균＜0.05）균대우SAP조，관강면적소우SAP조（P＜0.01），혈장 Lp（a）수평여연반괴면적백분비、편심지수화혈관중구지수（r＝0.365，P＝0.011；r＝0.448，P＝0.008화r＝0.432， P＜0.001）정정상관。결론 ACS조혈청Lp（a）수평명현고우SAP조화대조조，혈청Lp（a）수평여IVUS평개반괴역손성지표상관，Lp（a）가작위관상동맥역손반괴적평고인자。
Objective To assess the relationship of coronary atherosclerotic plaques detected by intravascular ultrasound(IVUS) and virtual histological imagining(IVUS-VH) with plasma lipoprotein(a) in patients with coronary disease. Methods Patients with acute coronary syndrome(ACS group), stable angina pectoris(SAP group) and control subjects(CTL) group were included in present study. Lipoprotein(a) were assayed by immunoturbidimetry. Coronary angiography(CAG) and IVUS/IVUS-VH were performed in all patients. The plaque compositions and features were assessed by IVUS-VH software. Results The levels of plasma lipoprotein(a) in ACS were remarkably higher than those in SAP group and CTL group;. More soft plaques were found in patients with ACS group than patients with SAP group(P<0.01). Compared with SAP group, lumen area significantly(P<0.01) decreased, remodeling index(RI) (P<0.05), eccentricity index(EI) (P<0.05) and plaque area (PA) (P<0.01)significantly increased. There were positive correlations between percentage of soft plaque and lipoprotein(a) (r=0.365, P=0.011), and between the plaque remodeling index and lipoprotein(a) (r=0.432, P<0.001), and between the EI and lipoprotein(a) (r=0.448, P=0.008). Conclusion Plasma lipoprotein(a) is correlated with the vulnerable features of the coronary plaque. The elevation of lipoprotein(a) may correlate with the plaque instability and rupture.