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老年冠心病患者颈动脉超声特征与斑块稳定性指标、<br />同型半胱氨酸的相关性

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摘要:

目的 探讨老年冠状动脉粥样硬化性心脏病(冠心病)患者颈动脉超声特征与斑块稳定性
指标、同型半胱氨酸(Hcy)的相关性。方法 选取192例老年冠心病患者作为研究对象,根据冠状动脉
(冠脉)病变程度分为单支病变组(69例)、双支病变组(74例)及三支病变组(49例)。通过颈动
脉彩超检查颈动脉内膜中层厚度(CA-IMT)及Crouse斑块积分,检测血清组织蛋白酶K(Cat K)、Ⅰ
型前胶原羧基端前肽(ⅠCTP)、基质金属蛋白酶(MMP)-1、MMP-9等斑块稳定性及同型半胱氨酸
(Hcy)指标。结果 三支病变组患者CA-IMT值、Crouse斑块积分及血清Cat K、ⅠCTP、MMP-1、MMP-9
和Hcy水平均高于单支病变组和双支病变组,双支病变组患者上述指标均高于单支病变组,差异有统计
学意义(P<0.05);根据CA-IMT值将研究对象分为内膜正常组(51例)、内膜增厚组(97例)和斑块
形成组(44例),斑块形成组患者血清Cat K、ⅠCTP、MMP-1、MMP-9和Hcy水平均高于内膜正常组
和内膜增厚组,内膜增厚组患者上述指标均高于内膜正常组,差异有统计学意义(P<0.05);研究对
象CA-IMT值与血清Cat K、ⅠCTP、MMP-1、MMP-9和Hcy指标呈明显正相关(r分别为0.516、0.499、
0.438、0.424和0.563),Crouse斑块积分与上述血清指标呈明显正相关(r分别为0.485、0.460、0.407、
0.398和0.530),差异均有统计学意义(P<0.05)。结论 随着老年冠心病患者冠脉病变程度加重,颈
动脉超声特征以及斑块稳定性、Hcy指标均存在明显的恶化趋势,且颈动脉超声指标与血清Cat K、Ⅰ
CTP、MMP-1、MMP-9和Hcy水平存在相关性,共同参与老年冠心病的粥样硬化的病情发展过程。

Abstract:

Objective To investigate the correlation among carotid artery ultrasound characteristics, plaque
stability indexes and homocysteine (Hcy) in elderly patients with coronary heart disease (CHD). Methods The
elderly CHD patients (n=192) were chosen and divided, according to severity of coronary artery lesions, into 1-vessel
lesion group (n=69), 2-vessel lesion group (n=74) and 3-vessel lesion group (n=49). Color ultrasonography was
applied to detect carotid artery intima-media thickness (CA-IMT) and Crouse plaque integrals. The indexes of
plaque stability including serum cathepsin K (Cat K), carboxyterminal propeptide of type I procollagen (ICTP),
matrix metalloproteinase-1 (MMP-1), MMP-9 and Hcy were detected. Results The levels of CA-IMT, Crouse
plaque integrals, Cat K, ICTP, MMP-1, MMP-9 and Hcy were all higher in 3-vessel lesion group than those in
1-vessel lesion group and 2-vessel lesion group, and was higher in 2-vessel lesion group than those in 1-vessel
lesion group (P<0.05). The patients were divided, according to CA-IMT values, into normal intimal group (n=51),
thickened intimal group (n=97) and plaque group (n=44). The levels of serum Cat K, ICTP, MMP-1, MMP-9 and
Hcy were all higher in plaque group than those in normal intimal group and thickened intimal group, and was
higher in thickened intimal group than those in normal intimal group (P<0.05). CA-IMT was positively correlated
significantly to levels of serum Cat K (r=0.516), ICTP (r=0.499), MMP-1 (r=0.438), MMP-9 (r=0.424) and Hcy
(r=0.563). Crouse plaque integrals was positively correlated significantly to levels of serum Cat K (r=0.485), ICTP
(r=0.460), MMP-1 (r=0.407), MMP-9 (r=0.398) and Hcy (r=0.530). Conclusion With the worsening of coronary
artery lesions in elderly CHD patients, carotid artery ultrasound characteristics, plaque stability and Hcy index have
a significant deterioration trend. The indexes of carotid artery ultrasound are correlated to levels of serum Cat K, I
CTP, MMP-1, MMP-9 and Hcy, and they are jointly involved in the development of atherosclerosis in elderly CHD.

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参考文献:

  • 2008

  • 1

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