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目的:通过64层计算机体层摄影冠状动脉血管造影识别冠状动脉临界病变患者的冠脉斑块成分,并检测血清基质金属蛋白酶-9(MMP-9)、可溶性CD40配体(sCD40L)水平,探讨其斑块稳定性及临床意义。方法:选择经64层计算机体层摄影冠状动脉血管造影证实至少有1支冠脉某一阶段狭窄30%～70%的患者65例,其中稳定型心绞痛36例,不稳定型心绞痛29例,通过斑块CT值及冠脉管腔碘造影剂CT值确定其斑块类型:非钙化斑块,钙化斑块和混合斑块;并用ELISA方法测定患者及37例无心血管疾病对照组血清MMP-9、sCD40L水平,比较其差异性并探讨其相互关系。结果:冠脉临界病变患者混合斑块最多,其次为非钙化斑块,钙化斑块最少,“混合斑块+非钙化斑块”显著多于钙化斑块数目;患者血清MMP-9、sCD40L水平显著高于无心血管疾病对照组。结论:冠心病冠脉临界病变斑块多为易损斑块。
OBJECTIVE: To identify the coronary plaque components in 64 patients with coronary artery lesions by 64-slice computer tomography coronary angiography and to detect the levels of serum matrix metalloproteinase-9 (MMP-9) and soluble CD40 ligand (sCD40L) Its plaque stability and clinical significance. Methods Sixty-five patients with at least one coronary artery whose stenosis was 30% -70% at a certain stage were confirmed by 64-layer computed tomography coronary angiography. Among them, 36 cases had stable angina pectoris and 29 cases had unstable angina pectoris, Plaque CT value and CT value of coronary lumen iodine contrast agent to determine the plaque type: non-calcified plaque, calcified plaque and mixed plaque; ELISA method was used to determine the serum concentration of MMP-9 and 37 patients without cardiovascular disease , SCD40L levels, compare their differences and explore the relationship between them. Results: The patients with coronary lesion had the largest number of mixed plaques, followed by non-calcified plaque, the least calcified plaque, the more mixed plaque + non-calcified plaque than the calcified plaque. The serum levels of MMP-9, sCD40L levels were significantly higher than those without cardiovascular disease control group. Conclusion: Coronary heart disease coronary lesions mostly vulnerable plaque.