【摘要】 目的探讨颈动脉内-中膜厚度(CIMT)、血清脂联素(APN)、血清基质金属蛋白酶-9(MMP-9)诊断冠状动脉不稳定斑块的价值。方法选取接受OCT检查的急性冠状动脉综合征(ACS)患者27例(ACS组),并选取同期来诊的急性胸闷、胸痛而冠状动脉造影阴性者30例为对照组。检测血清APN及MMP-9,并行颈动脉超声检查,并记录CIMT、APN、MMP-9和冠状动脉斑块纤维帽厚度;分析两组指标的差异及各指标之间的相关性,绘制ROC曲线评价各指标对薄纤维帽斑块的诊断价值。结果 ACS患者CIMT、MMP-9水平显著高于正常组(P<0.01),而APN水平显著低于正常组(P<0.01);冠状动脉斑块纤维帽厚度与CIMT及MMP-9呈负相关(r=-0.357,P<0.05;r=-0.477,P<0.01),与APN呈正相关(r=0.468,P<0.05);CIMT、MMP-9、APN联合检测诊断冠状动脉薄纤维帽斑块的ROC曲线下面积大于单个指标的曲线下面积(分别为:0.815、0.688、0.772、0.739)。结论 CIMT值及MMP-9水平升高、APN水平降低与冠状动脉斑块的稳定性密切相关,且三者联合对ACS更具诊断价值。更多还原

【Abstract】 Objective To study the value of carotid intima-media thickness(CIMT),matrix metalloproteinase-9(MMP-9)and Adiponectin(APN)in diagnosis of coronary unstable plaques.Methods Twenty-seven patients with acute coronary syndrome(ACS)examined with optical coherence tomography(OCT;ACS group),and thirty patients with acute chest pain and with negative coronary angiography as control group were enrolled.The serum levels of MMP-9and the serum levels of APN were measured,and the carotid ultrasound was performed on all subjects.The CIMT,the levels of MMP-9,the levels of APN,the thickness of the fibrous cap in coronary plaques were recorded and compared,ROC were drawn to evaluate the diagnostic value of thin fibrous cap plaque(TFCA).Results Compared with the control group,the serum MMP-9and CIMT were significantly higher while the serum adiponectin was significantly lower in ACS group(all P<0.01).There was negative correlation between fibrous cap thickness of coronary plaques and serum levels of MMP-9and CIMT(r=-0.357,all P<0.05;r=-0.477,P<0.01),positive correlation between fibrous cap thickness and serum levels of APN(r=0.468,P<0.05).The area under the ROC curve of CIMT,MMP-9,APN in diagnosis of TFCA were0.688,0.772,0.739,prospectively,and 0.815,combined.Conclusion The CIMT and serum levels of MMP-9increasing and the serum levels of APN decreasing have strong correlation with coronary plaque stability.And combined with CIMT,MMP-9and APN have a high diagnostic value of ACS.更多还原