血清YKL-40水平与冠状动脉罪犯血管斑块易损性的相关性研究

倪占玲; 杨宏辉; 陈岩; 张优; 高传玉

doi:10.13201/j.issn.1001-1439.2019.05.004

血清YKL-40水平与冠状动脉罪犯血管斑块易损性的相关性研究

- 阜外华中心血管病医院河南省人民医院心脏中心(郑州, 450008)
基金项目:
河南省卫生健康委员会科技攻关项目（No：YKL-40）

详细信息

通讯作者: 倪占玲,E-mail:nightingale_ni@hotmail.com

中图分类号: R541.4

收稿日期: 2018-09-10

Correlation between YKL-40 levels and fibrous cap thickness of fibrofatty plaque in coronary culprit lesions

- Fuwai Central China Cardiovascular Hospital Heart Centre of Henan Provincial People's Hospital, Zhengzhou, 450008, China

More Information

Corresponding author: NI Zhanling, E-mail: nightingale_ni@hotmail.com

Received Date: 10 September 2018

摘要

摘要: 目的：探讨血清炎性因子——高敏C反应蛋白（hs-CRP）、血清甲壳质酶蛋白40（YKL-40）水平与冠状动脉（冠脉）病变斑块纤维帽厚度之间的相关性。方法：入选2016-08-2018-08在河南省人民医院心内科择期行冠脉造影的冠心病患者60例，对其临床资料进行回顾性分析。根据冠心病的临床类型，将患者分为稳定性心绞痛（SAP）组（22例）、不稳定性心绞痛（UAP）组（28例）和急性心肌梗死（AMI）组（10例）。检测患者术前血清hs-CRP、YKL-40水平，术中在介入治疗前使用光学相干断层成像（OCT）观察病变斑块的特征，并分析血清hs-CRP、YKL-40水平与纤维脂质斑块纤维帽厚度之间的关系。结果：①AMI组术前血清hs-CRP[（6.85±1.74） mg/L：（3.86±0.18） mg/L：（4.12±0.52） mg/L，均P<0.05]和YKL-40[（65.16±24.34） ng/ml：（38.65±10.36） ng/ml：（54.81±20.58） ng/ml，均P<0.05]水平均高于SAP组和UAP组。UAP组术前血清hs-CRP和YKL-40水平均高于SAP组（均P<0.05）.②AMI组和UAP组的罪犯病变纤维脂质斑块纤维帽厚度均小于SAP组[（57.28±8.61）μm：（68.56±16.57）μm：（130.42±32.83）μm，均P>0.05]，AMI组与UAP组之间的罪犯病变纤维脂质斑块纤维帽厚度差异无统计学意义（P>0.05）。AMI组薄纤维帽斑块[80.00%（8/10）：18.18%（4/22）：60.71%（17/28），均P<0.05]和血栓形成[30.00%（3/10）：4.54%（1/22）：10.71%（3/28），均P<0.05]的比例均高于SAP组和UAP组；AMI组斑块内钙化的比例低于SAP组[10.00%（1/10）：40.91%（9/22），P>0.05]，与UAP组[21.43%（6/28）]之间差异无统计学意义（P>0.05）。③Pearson相关分析显示，术前血清hs-CRP （r=-0.265，P<0.01）和YKL-40（r=-0.524，P<0.01）水平与纤维脂质斑块纤维帽厚度均呈负相关；Spearman相关分析显示，术前血清hs-CRP水平与冠心病患者斑块破裂（r=0.462，P<0.01）和血栓形成（r=0.218，P<0.01）呈正相关，术前血清YKL-40水平与冠心病患者斑块破裂（r=0.561，P<0.01）和血栓形成（r=0.239，P<0.01）也呈正相关。④多因素logistic回归分析显示，血清YKL-40水平与薄纤维帽粥样斑块独立相关（OR=6.341，P<0.01）。结论：AMI和UAP患者的血清hs-CRP和YKL-40水平均高于SAP者，AMI、UAP和SAP患者罪犯病变的纤维脂质斑块性质有明显差别，AMI患者出现薄纤维帽粥样斑块、斑块破裂及血栓形成的比例较高，而SAP患者出现斑块钙化的比例较高；血清YKL-40水平与冠心病患者罪犯病变的薄纤维帽粥样斑块形成独立相关。
- 冠心病 /
- 甲壳质酶蛋白40 /
- 动脉粥样硬化
Abstract: Objective: To identify the correlation between YKL-40 levels including high sensitive C reactive protein(hs-CRP) and the fibrous cap thickness of fibrofatty plaque in coronary culprit 1esions.Method: We retrospectively analyzed the clinical data of 60 patients with coronary artery disease admitted to our hospital from August 2016 to August 2018.According to the type of coronary disease, patients were divided into 3 subgroups:SAP group (containing 22 stable angina patients), UAP group (containing 28 unstable angina patients), and AMI group (containing l0acute myocardial infarction patients).Serum hs-CRP and YKL-40 levels were measured before subsequent procedures.The characteristics of the culprit lesions were detected by optical coherence tomography (OCT) before interventional treatment, and the correlation between hs-CRP and ykl-40 and the fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were analyzed.Result: ①The serum levels of hs-CRP[(6.85±1.74) mg/L vs (3.86±0.18) mg/L vs (4.12±0.52) mg/L, respectively, all P<0.05] and YKL-40[(65.16±24.34) ng/ml vs (38.65±10.36) ng/ml vs (54.81±20.58) ng/ml, respectively, all P<0.05] were significantly higher in AMI group than in SAP group and UAP group.Besides, serum levels of hs-CRP and YKL-40 were significantly higher in UAP group than in SAP group(all P<0.05).②The fibrous cap thickness of fibrofatty plaque in coronary culprit lesions were smaller in AMI group and UAP group than in SAP group[(57.28±8.61) μm vs (68.56±16.57) μm vs (130.42±32.83) μm, respectively, all P<0.05], and there was no significantly difference between AMI group and UAP group (P>0.05).Proportion of thin-cap fibroatheroma plaque[80.00%(8/10) vs 18.18%(4/22) vs 60.71%(17/28), respectively, all P<0.05], plaque rupture[40.00%(4/10) vs 4.54%(1/22) vs 32.14%(9/28), respectively, all P<0.05] and thrombosis[30.00%(3/10) vs 4.54%(1/22) vs 10.71%(3/28), respectively, all P<0.05] were significantly higher in AMI group than in SAP group and UAP group.Proportion of calcification in plaque was lower in AMI group than in SAP group[10.00%(1/10) vs 40.91%(9/22), P<0.05], and there was no significantly difference between AMI group and UAP group (P>0.05).③Pearson correlation analysis showed that serum levels of hs-CRP (r=-0.265, P<0.05) and YKL-40 (r=-0.524, P<0.01) were negatively correlated with fibrous cap thickness of fibrofatty plaques.Spearman correlation analysis showed that serum levels of hs-CRP were positively correlated with plaque rupture (r=0.462, P<0.01) and thrombosis (r=0.218, P<0.01), and serum levels of YKL-40 was positively correlated with plague rupture (r=0.561, P<0.01) and thrombosis (r=0.239, P<0.01).④Multiple logistic regression analysis showed that serum levels of YKL-40 at baseline was independently related to thin-cap fibroatheroma plaque (OR=6.341, P<0.01).Conclusion: The serum levels of hs-CRP and YKL-40 in AMI patients are much higher than that in SAP and UAP patients, and higher in UAP patients than in SAP patients.Prevalence of thin-cap fibroatheroma plaque, plaque rupture and thrombosis was significantly higher in the AMI patients, while the prevalence of calcification in plaque is more often in SAP patients.Increased serum levels of YKL-40 are independent risk factor of thin-cap fibroatheroma plaque formation.
- coronary disease /
- YKL-40 /
- atherosclerosis

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