| Background:Coronary heart disease(CHD)has become a common cardiovascular disease which is a serious menance to human health,it is crucial to correctly estimate the degree of coronary artery stenosis and the characteristics of coronary plaques in the diagnosis and treatment of CHD.Inflammation plays an important role in the process of formation and development of coronary atherosclerosis,and which is closely associated with atherosclerotic plaque vulnerability.The occurrence of acute coronary events is often caused by vulnerable plaque rupture and driven thrombogenesis.Intravascular imaging examination is the most accurate clinical assessment of coronary plaque characteristics,and optical coherence tomography(OCT)is one of the best tools to accurately observe and discover vulnerable plaques with a high resolution in catheterization lab.It may help early discrimination and accurate treatment for high-risk patients with CHD by comparing the levels of serum inflammatory factors in different risk stratification of patients with CHD and discussing the relation between the plaques characteristics detected from OCT in de novo lesions of native vessels and level of inflammation factors.Objective:To detect the serum level of some inflammatory factors such as hypersensitive C-reactive protein(hs-CRP)and lipoprotein-associated phospholipase A2(Lp-PLA2)in patients with CHD and investigate the morphological characteristics of de novo lesions of native vessels detected by OCT,than investigate the relationship between the characteristics of coronary de novo lesions of native vessels and serum levels of inflammatory factors.Methods:A total of two hundred and sixty-three patients who admitted to cardiovascular department of Nanjing First Hospital from September 2014 to January 2017 and were dignosed with CHD confirmed by coronary angiography(CAG)were enrolled in our observational study,who were divided into stable angina pectoris(SAP,n=83)group,unstable angina pectoris(UAP,n=145)and acute nonST/ST segment elevation myocardial infarction(AMI,n=35)group according to the diagnostic criteria of symptom and myocardial enzyme level at admission.Serum levels of hs-CRP and Lp-PLA2 were measured by enzyme linked immunosorbent assay and turbidimetry when the second day in hospital and an empty stomach.All patients,de novo lesions which confirmed more than 50%stenosis by CAG were detected by OCT before percutaneous coronary intervention(PCI).Plaques' characteristics were qualitatively defined as stable plaque(fibrous plaque,thick-cap fibroatheroma and thick-cap calcified plaque)and vulnerable plaque(thin-cap fibroatheroma(TCFA),plaque erosion(PE)and calcified nodule)based on the OCT imaging.The correlation between vulnerable plaque and inflammatory factors were analysed statistically by the SPSS 21.0 software package.P<0.05 was considered statistically significant.Results:1.The level of serum Lp-PLA2 and hs-CRP in AMI group was significantly higher than in UAP group and in SAP group(P<0.01),and also the level of serum Lp-PLA2 and hs-CRP in UAP group was significantly higher than that in SAP group(P<0.01).2.The patients were also divided into one-vessel disease(n=130),double-vessel disease(n=69)and multiple-vessel disease(n=64)group depending on the number of major coronary vessels with diameter stenosis>50%,inflammatory factors levels were compared between the three groups.It was detected that the levels of serum Lp-PLA2 and hs-CRP have not significant difference between the three groups(P>0.05).3.The AMI and UAP group have more indicidence of TCFA and PE and the fibrous cap thickness(FCT)of de novo lesions were thinner compared with SAP group(P<0.01),and the AMI group has more indicidence of TCFA,plaque rupture(PR),thrombosis and also the FCT were thinner compared with UAP and SAP group(P<0.01).4.Serum Lp-PLA2 level higher than 200 mmol/L was recognized as elevated group(n=167)according to guideline of ACC/AHA,while Serum Lp-PLA2 level less than 200 mmol/L was defined as normal group(n=96),then discover the characteristics by OCT between the two groups.The incidence of TCFA(51.5%vs.10.4%,P<0.001),PR(17.4%vs.3.1%,P<0.001)and thrombosis(21.6%vs.1.0%,P<0.001)were significantly higher in elevated group compared with normal group.And the FCT was significantly thinner in elevated group compared with normal groups(84.73±38.57?m vs.157.29±64.67?m,P<0.001).While the normal group has more incidence of fibrous palque(34.4%vs.16.2%,P=0.001).Similarly,serum hs-CRP level higher than 2.0?g/ml was recognized as elevated group(n=80),while less than 2.0?g/ml was defined as normal group(n=183).The incidence of TCFA(56.3%vs.27.9%,P<0.001),PE(11.3%vs.3.8%,P=0.020),PR(22.5%vs.7.7%,P=0.001)and thrombosis(26.3%vs.8.7%,P<0.001)were significantly higher in elevated group compared with normal group,and the FCT was significantly thinner in elevated group compared with normal groups(81.38±39.96?m vs.124.26±63.62?m,P<0.001).5.Negative correlation was discovered between the FCT of de novo lesions and serum level of Lp-PLA2 and hs-CRP,and negative correlations were also discovered in different stratification of CHD.6.Receiver operator characteristic(ROC)confrmed that Lp-PLA2 is better than hs-CRP on the predictive value of TCFA and PR.The area under the curves(AUC)for TCFA and PR were 0.796 and 0.725(P<0.01),and the Lp-PLA2 concentration of 240.5mmol/L would detect TCFA with a sensitivity of 80.2%and a specificity of 70.7%;the Lp-PLA2 concentration of 308.0mmol/L would detect PR with a sensitivity of 65.6%and a specificity of 73.6%.The AUC of hs-CRP for TCFA and PR were 0.716 and 0.666(P<0.01),and the hs-CRP concentration of 1.23g/ml would detect TCFA with a sensitivity of 72.9%and a specificity of 59.9%;the hs-CRP concentration of 2.675g/ml would detect PR with a sensitivity of 53.1%and a specificity of 81.0%.Logistic regression analysis showed that the level of serum Lp-PLA2 may be an independent predictor of TCFA and PR,odds ratio were 1.010 and 1.008(P<0.01),95%confidence interval were 1.006 to 1.014 and 1.003 to 1.012.Conclusion:1.The levels of serum Lp-PLA2 and hs-CRP showed significant difference in different types of CHD,the levels of Lp-PLA2 and hs-CRP in AMI group were higher than that in UAP and SAP group,value of Lp-PLA2 and hs-CRP were higher in UAP group than that in SAP group.2.The characteristics of de novo lesions have difference in different types of CHD,more incidence of TCFA and PE and thinner FCT of de novo lesions were found in AMI and UAP groups than that in SAP group,and more incidence of TCFA and PR and thinner FCT were found in AMI group than that in UAP and SAP groups.3.There were negative correlations between the FCT of native lesions and serum level of Lp-PLA2 and hs-CRP.However,Lp-PLA2 had more distinct correlation with the FCT of de novo lesions compared with hs-CRP.4.The levels of serum Lp-PLA2 and hs-CRP were related with plaque vulnerability,the Lp-PLA2 is better than hs-CRP on the predictive value of TCFA and PR.The level of serum Lp-PLA2 may be an independent predictor of TCFA and PR in patients with CHD. |
PDF Full Text Request