天津医药

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冠状动脉血管重塑与脂代谢异常及斑块稳定性关系的初探

金喆1,李敬伟2,康宁3,党群1   

  1. 1. 天津市南开医院
    2. 天津市第一中心医院
    3. 中国医学科学院基础医学研究所
  • 收稿日期:2010-03-11 修回日期:2010-06-08 出版日期:2010-10-15 发布日期:2010-10-15
  • 通讯作者: 金喆

  • Received:2010-03-11 Revised:2010-06-08 Published:2010-10-15 Online:2010-10-15

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摘要： 目的 以血管内超声法评价冠状动脉代偿性扩张与脂代谢异常及斑块性质之间的关系，并结合超敏C反应蛋白、白细胞介素-6以及内皮素水平的测定结果探讨血管重塑的可能机制。方法 将冠状动脉造影确定为单支局限性病变的56例患者，分为代偿性扩张组（30例）和无代偿性扩张组（26例）。对冠状动脉重塑指数和血脂成分做相关性分析，并对两组间血脂水平、炎症指标、内皮素和不同斑块性质分布进行对比分析。结果 与无代偿性扩张组相比，代偿性扩张组患者血清低密度脂蛋白明显增高（2.86±0.43 mmol/L vs. 2.59±0.57 mmol/L，P<0.05），高密度脂蛋白水平明显降低（1.29±0.25 mmol/L vs. 1.51±0.29 mmol/L，P <0.01），重塑指数与总胆固醇、低密度脂蛋白呈正相关，而与高密度脂蛋白呈负相关。另外，代偿性扩张组炎性指标较高，出现偏心性软斑块的几率较高，无代偿性扩张组内皮素水平较高，更易出现斑块钙化。结论 血管重塑与脂代谢异常以及病变部位斑块性质密切相关。炎症反应和内皮功能紊乱引起的内皮素分泌失衡可能是血管重塑的机制。

关键词: 血管重塑, 血管内超声, 脂代谢异常, 代偿性扩张

Abstract: Abstract: Objective To explore the relationship between dyslipidemia, plaque characteristics and coronary artery compensatory enlargement, and to study the possible mechanisms of vessel remodeling by detecting hypersensitive C reactive protein, interleukin-6 and endothelin. Methods Fifty-six patients with local lesion within single coronary segment were selected and separated into two groups, compensatory enlargement group (30 patients) and non-compensatory enlargement group (26 patients). Correlation between remodeling index and blood lipid composition was analyzed. Blood lipid level, inflammatory markers, endothelin, and plaque distribution between the two groups were also compared. Results Compared to the non-compensatory enlargement group, patients with compensatory enlargement had significantly higher serum low density lipoprotein (2.86±0.43 mmol/L vs. 2.59±0.57 mmol/L，P<0.05), whereas lower serum high density lipoprotein (1.29±0.25 mmol/L vs. 1.51±0.29 mmol/L，P<0.01). There was a positive correlation between the remodeling index and total cholesterol, so did the remodeling index and low density lipoprotein. However, a negative correlation existed between the remodeling index and high density lipoprotein. In addition, the compensatory enlargement group had higher level of inflammatory markers and higher incidence of eccentric, soft plague. The non-compensatory enlargement group had higher endothelin level and tended to have calcified plague. Conclusion Coronary vessel remodeling was closely related to dyslipidemia and plaque characteristics. The inflammatory response and endothelin imbalance resulted from endothelium dysfunction might be the mechanisms of vessel remodeling.

Key words: Vessel remodeling, Intravascular Ultrasound, Dyslipidemia, Compensatory Enlargement