Distinguish Value Of Coronary Artery Unstability Plaque By Combining 64-slice Spiral Computed Tomography Coronary Angiography With Inflammatory Mediators

Objective:To evaluate value of coronary artery unstability plaque by combining 64-slice spiral computed tomography coronary angiography with High sensitive C-Reactive protein (Hs-CRP),interleukin-6(IL-6) and homocystein(Hcy).Methods:120 patients with suspected coronary heart disease(CHD) underwent 64-slice spiral CT coronary angiography and coronary angiography(CAG) to distinguish the quality of plaque of coronary artery lesions.According to the CT scale,these patients were divided into four groups:normol group(30 cases),vulnerable plaque group(30 cases ),mix plaque group (30cases) and hard plaque group(30cases).According to the clinical diagnose they were divided into Three groups:normol group(30 cases),acute coronary syndrome(ACS) group(56 cases) and stable angina pectoris(SAP) group(34 cases);Blood samples were taken to measure levels of serum Hs-CRP,IL-6 and Hcy before angiography in all patients.Result:(1) For CAG as the standard,64-slice spiral CT detection rate of 80%of the Total plaque.all branches of the Proximal and middle plaque detection rates were right coronary artery (RCA) 78%,71%;left anterior descending(LAD) 95%,78%;left circumflex(LCX) 86%,100%;Distal branches had far lower rate of≤50%detection;RCA had a lower percentage detection rate of plaque than LAD and LCX.(2) The comparison of the levels of serum Hs-CRP,IL-6 and Hcy among plaque groups:Mean levels of serum Hs-CRP,IL-6 and Hcy in three plaque groups was obvious higher than that in normol group(P＜0.01),Mean levels of serum Hs-CRP,IL-6 and Hcy in vulnerable plaque group and mix plaque group was obvious higher than that in hard plaque group(P＜0.01),but there is no statistical difference between vulnerable plaque group and mix plaque group(P＞0.05).(3) The comparison of distribution of different quality plaque between ACS group and SAP group:Distributing of vulnerable plaque and mix plaque in ACS group was significantly higher than that in SAP group(p＜0.01),Distributing of hard plaque in SAP group was significantly higher than that in ACS group(P＜0.01).(4) The comparison of the levels of serum Hs-CRP,IL-6 and Hcy among three clinical groups:Mean serum Hs-CRP,IL-6 and Hcy levels ACS group and SAP group was significantly higher than that in normol group(P＜0.01),Mean serum Hs-CRP,IL-6 and Hcy levels in ACS group was significantly higher than that in SAP group(P＜0.01).(5)There is negative correlation between the CT scale and Hs-CRP,Hcy and IL-6 in vulnerable plaque group(P＜0.01).There is positive correlation between the plaque burden and Hs-CRP,Hcy and IL-6 in vulnerable plaque group (P＜0.05).(6) The comparison of the plaque burden among plaque groups:Mean levels of the plaque burden in vulnerable plaque group and mix plaque group was obvious higher than that in hard plaque group(P＜0.01),but there is no statistical difference between vulnerable plaque group and mix plaque group(P=0.246).Coneulsion:(1) 64-slice spiral CT coronary angiography can be used in the quantitative diagnosis of coronary artery lesions and plaque with a higher accuracy rate.(2) 64-slice spiral CT coronary angiography may a accuracy noninvasive way to distinguish different quality plaque of coronary artery lesions of CHD patient.(3) serum Hs-CRP,IL-6 and Hcy level can be considered as one of the indexes to judge the degree of CHD and may reflect the vulnerability of plaque in CHD patient.(4) Combining 64-slice spiral CT coronary angiography with serum level of Hs-CRP,IL-6 and Hcy could contribute preferably to distinguishing coronary artery vulnerable plaque and vulnerable patinet in clinic,it is important for clinical diagnosis and risk evaluation of CHD patient.