Research On Predicting Vulnerable Coronary Plaque By Carotid Ultrasound Combined With Serum MMP-9 And APN

Objective: 1. To identify the changes of the carotid intima-media thickness(CIMT),the serum levels of matrix metalloproteinases-9(MMP-9) and adiponectin(APN) and in acute coronary syndrome(ACS) patients. 2. To test the coronary plaque thickness of fibrous cap and to explore the relationship between coronary plaque fibrous cap thickness and CIMT, MMP-9, APN in ACS patients. 3. To clarify the combinession diagnostic value of CIMT, serum MMP-9 and APN to vulnerable coronary atherosclerotic plaque.Methods: 27 ACS patients diagnosed by coronary angiography(CAG) and agreed to further done OCT examnation and 30 actue chest pian patients with negative coronary angiography from January 2013 to June 2014 were choosed as research subjects. Siemens S2000 corlor Doppler ultrasonic diagnostic apparatus were used for application.All the research subjects were done the exam of carotid ultrasound strictly according to the protocol of international vascular ultrasonography.One point method were used to mearsure the CIMT,each patients shoud be mearsured three times and record the average,observe and record the carotid plaque.The coronary angiography were done by Philips angiography machine via right radial artery or femoral artery, read and record the extent of coronary artery disease.The M2 OCT system were used to identify the coronary plaque fiberous cap thickness.The serum levels of MMP-9 and APN were measured by enzyme linked immunosorbent assay(ELISA). Data were analyzed by SPSS 17.0 statistical analysis software. All the measurment data should be done the normality teset and showed by the way of mean±standard, the means of two groups were compared by t test, the means of many groups were compared by one-way ANOVA. The count data were compared by chi-square test. Pearson linear correlation analysis were used to identify the correlation between the fibrous cap thickness of coronary plaque and CIMT, serum MMP-9, serum APN. ROC curve were drawed to evaluate the sensitivity and specificity of CIMT, MMP-9, APN and their combination to the TCFA(Thin Cap Fibroatheromas).Results: 1. The CIMT and levels of serum MMP-9 were significantly higher while the levels of serum APN was significantly lower in ACS group compared with the acute chest pain group(P<0.01). 2. The CIMT and levels of serum MMP-9 were significantly higher while the levels of serum APN was significantly lower in group which coronary plaque fibrous cap thickness≤65μm compared with the group which fibrous cap thickness>65μm(P<0.01). 3. There was a significant negative linear relationship between the fibrous cap thickness of coronary plaque and serum levels of MMP-9(r =-0.477,P<0.01), positive linear relationship between the fibrous cap thickness of coronary plaque and serum levels of APN(r = 0.468,P<0.05). 4. There was a significant positive correlation between CIMT and serum levels of MMP-9(r =0.880,P<0.01), and negative correlation between CIMT and serum levels of APN(r =-0.715,P<0.01). 5. The area under ROC curve of the combination of CIMT, MMP-9, APN were larger than the thress indicators respectively to TCFA(respectively 0.815, 0.688, 0.772, 0.739).According to the ROC curve, the best diagnostic critical point of CIMT, MMP-9 and APN to TCFA were 1.40 mm, 18.45ng/ml, 6.07mg/l, respectively. The sensitivity and specificity of them in predicting TCFA were CIMT(83.1%, 94.5%), MMP-9(73.6%, 82.9%), APN(63.9%, 79.6%), respectively.Conclusion: 1. MMP-9 and APN may participate in the pathogenesis and progression of CHD(coronary heart disease), the serum levels of MMP-9 and APN will contribute to the assessment of the severity of CHD. 2. The serum levels of MMP-9 and APN may reflect the stability of coronary plaque. There were a significant negative liner relationship between the fibrous cap thickness of coronary plaque and serum levels of MMP-9, positive linear correlation between the fibrous cap thickness of coronary plaque and serum levels of APN. 3. CIMT combined with the serum levels of MMP-9 and APN has high diagnostic value to the vlunerable coronary plaque.