海南医科大学学报

目的:分析冠脉CT血管造影(CTA)对冠状动脉斑块性质的评估价值及其与血小板功能、血清生化指标的相关性。方法:450例冠心病患者经CTA分为钙化斑块组(CT值≥130 HU)117例、软斑块组(CT值≤60 HU)150例、混合斑块组(CT值60~130 HU)183例,另取同期在本院接受体检的健康人100例作为对照组。对比4组研究对象的血小板功能、血清生化指标差异,分析CTA检测所得粥样斑块CT值与冠心病病情严重程度的判断价值。结果:软斑块组患者外周血血小板功能参数血小板平均体积(MPV)、血栓最大坚固度(TEG-MA)、P选择素(P-selectin)、血小板衍生生长因子BB(PDGF-BB)、血管假性血友病因子(v WF)水平、血清炎症因子血清C反应蛋白(CRP)、白介素-6(IL-6)、白介素-12(IL-12)、白介素-18(IL-18)、白介素-23(IL-23)含量、血清趋化因子单核细胞趋化因子-1(MCP-1)、趋化因子CXCL16、趋化因子Fractalkine、T细胞趋化因子(RANTES)含量、血清脂肪细胞因子瘦素(Leptin)、视黄醇结合单核蛋白4(RBP4)含量均高于其余3组(P<0.05)。分泌型卷曲相关蛋白5(SFRP5)含量低于其余3组(P<0.05)。冠心病患者粥样斑块CT值与血小板功能、血清生化指标含量存在直接相关关系。结论:冠脉CTA可准确评估冠脉粥样斑块性质,同时可作为判断冠心病病情严重程度、治疗预后等的可靠无创手段。

Objective: To analyze the evaluation value of coronary CT angiography for coronary plaque features and its correlation with platelet function and serum biochemical indexes. Methods: A total of 450 patients with coronary heart disease were divided into calcified plaque group( CT value≥130HU)( n = 117),soft plaque group( CT value ≤60HU)( n = 150) and mixed plaque group( CT value 60-130HU)( n = 183) by coronary CT angiography( CTA),and 100 healthy subjects who received physical examination in our hospital during the same period were selected as control group. Differences in platelet function and serum biochemical indexes were compared among four groups of patients,and the judgment value of atheromatous plaque CT value from CTA for the severity of coronary heart disease was analyzed. Results: Platelet function parameters MPV,TEG-MA,P-selectin,PDGF-BB and vWF levels in peripheral blood of soft plaque group were higher than those of the other three groups; inflammatory factors CRP,IL-6,IL-12,IL-18 and IL-23 content in serum were higher than those of the other three groups; chemokines MCP-1,CXCL16,Fractalkine and RANTES content in serum were higher than those of the other three groups; adipocytokines Leptin and RBP4 content in serum were higher than those of the other three groups while SFRP5 content was lower than those of the other three groups. Atheromatous plaque CT value in patients with coronary heart disease was directly correlated with platelet function and the content of serum biochemical indexes. Conclusion: Coronary CTA can accurately assess coronary atheromatous plaque features,and can also be a reliable noninvasive method to judge coronary heart disease severity,treatment prognosis and so on.