The Study Of Correlation Between Several Biomarkers And Stability Of Atherosclerosis Plaque

Background Atherosclerotic plaque which is the most common vascular lesions, the primary reason result in coronary heart and ischemic cerebrovascular disease lead to cardiovascular and cerebrovascular disease that is the world’s highest incidence, mortality and morbidity of the disease. Traditionally, the lumen artery stenosis degree as Important indicator to predict acute cardiovascular and cerebrovascular events occurred, However, the observation of clinical cases have found that The extent of arterial stenosis in patients with acute coronary syndrome and acute ischemic stroke occurred not as a parallel relationshipthe. More and more studies have showed that the occurrence of acute cardiovascular and cerebrovascular events depends not only on the degree of stenosis of the arterial lumen, the more important factor is the formation and development of atherosclerotic unstable plaques (vulnerable plaque).the unstability of atherosclerosis (Atherosderosis, AS) plaque to patch the rupture, thrombosis, and vascular obstruction is is the main cause of acute cardiovascular and cerebrovascular events happen. Unstable plaques (also known as vulnerable plaque) is the rupture tendency and easy formation of thrombus plaque, identification of the pathological features of vulnerable plaque have reached a consensus, which is characterized by active state of inflammation. Reduced collagen content, Lower density of smooth muscle cells, extensive infiltration of inflammatory cells (such as macrophages, T lymphocytes and mast cells) and a thin, eccentric fibrous cap, large lipid core plaque dehiscence calcified nodules, the vascular adventitia visible neovascularization, intraplaque hemorrhage, stenosis more than90%.Clear the mechanism of the vulnerable plaque to prevent the occurrence of acute cardiovascular and cerebrovascular events have a very important theoretical and clinical significance now think the vessel wall inflammation in atherosclerosis initiation, progress and end stage (the plaque to the unstability and plaque rupture phase) play a pivotal role, Inflammatory mechanisms play an important rolein the structural vulnerable plaque to vulnerable plaque functional transformation processes. Studies have shown that a large number of inflammatory cells in the plaque fibrous cap rupture site or the junction of the fibrous cap, such as monocytes, macrophages and T lymphocytes, the morphology of the cause of the event include activation of endothelial cell dysfunction, and then produce the interaction of adhesion molecules and inflammatory cells, such as macrophages secrete a variety of cytokines, growth factors and chemokines, leading to smooth muscle cell activation and proliferation, the final degradation of the matrix components of the fibrous cap of atherosclerotic plaque more vulnerable, the local inflammatory response to promote the formation and rupture of unstable plaque, on this basis, platelet activation and fibrinogen mediated cause thrombosis. Histopathological studies have shown that vulnerable plaque lipid core contains many cytokines, tissue factor, tumor necrosis factor and so on many kinds of inflammatory markers, high levels of inflammatory markers in peripheral blood is closely related to partial thrombosis formation.At present evaluation of plaque stability is imaging studies and biochemical markers, imaging detection of unstable plaques in various ways, Such as multi-slice spiral computer tomography, electron beam computed tomography, positron emission computed tomography imaging, high-resolution magnetic resonance imaging, coronary angiography, intravascular ultrasound imaging, optical coherence tomography, coronary vascular microscopy.intravascular ultrasound (IVUS) in the evaluation of atherosclerotic plaque has its unique advantages, intravascular ultrasound (IVUS) can accurately evaluation of arterial stenosis, the nature of the plaque, plaque size, composition, fibrous cap thickness lipid core size, plaque rupture or not, and thrombus formation,which is the main blood vessels to check for acute coronary syndrome, however, because of the invasive technique, complications and expensive, are not yet widely carried out, so the effective noninvasive evaluation of the vulnerable plaque, such as biochemical markers of more and more the attention of clinicians. In particular, need simple and practical reflection of arterial atherosclerosis plaque stability laboratory indicators to guide treatment, and targeted screening high-risk patients in the acute cardiovascular and cerebrovascular events before they occur and strengthening of treatment.Objective This study from atherosclerotic plaque formation mechanism, such as oxidatie stress, inflammation, blood coagulation and immune reaction pathophysiological mechanism, selected to reflect these changes in malondialdehyde (MDA), C-reactive protein (CRP), white interleukin-6(IL-6), fibrinogen (FIB), soluble CD40ligand (sCD40L), Through the relationship of these biochemical markers with stability of carotid atherosclerotic plaques, for the early detection of atherosclerotic plaque and evaluation of plaque stability lay a theoretical basis for seeking more specific biochemical indicators and specific treatment.Methods From hospitalized patients admitted to Department of Cardiology, Nanfang Hospital, Select a total of102cases diagnosed by color Doppler ultrasound examination of carotid artery atherosclerotic plaque, atherosclerosis stable plaque group, atherosclerotic unstable plaques results are divided into groups based on color Doppler ultrasound.Select hospital medical center over the same period of carotid color Doppler ultrasound examination of50healthy subjects as control group (no plaque group). All objects to exclude the following cases:acute and chronic infection and immune response in patients with disease; patients with malignant tumors; within1month of surgery or trauma; severe anemia, coagulation disease; serious liver and kidney dysfunction; cardiac function Ⅲ-Ⅳ class patients; or ongoing steroid treatment; acute coronary syndrome and patients with acute cerebral ischemic disease. Detailed clinical data collection for each object, including the general situation of the patients, such as admission systolic blood pressure (SBP), diastolic blood pressure (DBP), age, gender, smoking history, drinking history, confirmed a history of hypertension, history of diabetes, coronary heart disease history, history of cerebral infarction. At the same time Blood samples were measured, the plasma of malondialdehyde (MDA), C-reactive protein (CRP), interleukin-6(IL-6), fibrinogen (FIB), soluble CD40ligand (sCD40L) were respectively determined in three groups, Data obtained using the SPSS statistical software, measurement data by the mean±standard deviation (x±s), the difference between the groups using analysis of variance, homogeneity of variance between the two groups, q test was used; heterogeneity of variance, The approximate F-test and Welch method was used, the difference between the groups using the comparison method and Dunnett the T3; count data using the x2test; correlation analysis by Spearsman linear correlation, P <0.05with a statistical significance.Resultes Three groups of the study of the general material, including age, sex, smoking, alcohol consumption, body mass index, high blood pressure, diabetes and triglycerides, low density lipoprotein cholesterol, high-density lipoprotein cholesterol (hdl-c), total cholesterol level-cholesterol, which are no significant difference (P>0.05). Plasma levels of CRP, IL-6, sCD40L in the unstable atherosclerotic plaque group were signficantly higher than those in the stable plaque group and control group (P<0.05), and the levels of these3biomarkers in the stable plaque group were signficantly higher than those in the control group (P<0.05); plasma level of FIB,MDA in the unstable plaques group and stable plaques group were significantly higher than that in the control group (P<0.05), FIB,MDA did not differ significantly between the two atherosclerotic plaque group (P>0.05); the correlation analysis of Spearsman showed that the grades of plaque index was positively correlated with plasma levels of FIB, sCD40L, IL-6, CRP,MDA. As sCD40was strongly correlated with the grades of plaque index (r=0.748).Conclution1, biochemical markersof CRP, IL-6, MDA, FIB and sCD40L is closely related to atherosclerotic plaque formation,plasma level of IL-6, CRP, the level of sCD40L not only with the occurrence and development of the atherosclerotic plaque. and play an important role in the atherosclerotic plaque from stable to unstable, as the sensitivity and high specificity of biochemical markers, IL-6, of sCD40L is expected to become the evaluation of plaque stability and forecast spot block breakdown of the preferred biochemical markers.2, there was a close relatinonship between Plasma levels of CRP, IL-6, MDA, FIB and sCD40L and the complexity of plaque formation, the results have shown sCD40was strongly correlated with the grades of plaque index, plasma levels of sCD40L detection, intervention treatment is expected to play an important role in plaque stabilization and may also prevent the development of atherosclerotic plaque, delaying the progress of vascular stenosis.