摘要目的 研究缺血性脑血管病患者血清炎性标志物水平与颈动脉斑块稳定性之间的相关性,评估各血清炎性标志物对易损性颈动脉斑块的识别能力.方法 选取2008年3月至2010年3月65例存在颈动脉斑块的患者,根据斑块的MRI影像学特征分为稳定斑块组(21例)和不稳定斑块组(44例).不稳定斑块组根据纤维帽是否破裂又分为未破裂斑块组(29例)和破裂斑块组(15例).应用ELISA法测定患者血清可溶性白细胞分化抗原40配体(sCD40L)、基质金属蛋白酶-9( MMP-9)、妊娠相关血浆蛋白(PAPP-A)水平.结果 不稳定斑块组、未破裂斑块组和破裂斑块组患者血清sCD40L、MMP-9水平均高于稳定斑块组,差异均有统计学意义(sCD40L:x2=6.45、12.04和16.23,P＜0.01；MMP-9:F=2.55、5.10和4.69,P＜0.05).不稳定斑块组和破裂斑块组患者血清PAPP-A浓度水平均高于稳定斑块组,差异均有统计学意义(x2=11.71和13.55,P＜0.05),破裂斑块组患者血清PAPP-A浓度水平高于未破裂斑块组,差异均有统计学意义(x2=13.19,P=0.000).sCD40L≥673.22 ng/L(OR=22.47,95％ CI:2.11～239.81,P=0.01)、MMP-9≥84.09 μg/L( OR=10.01,95％ CI:1.74～57.78,P=0.01)、PAPP-A≥0.101 μg/L(OR=14.29,95％ CI:2.69 ～ 75.90,P =0.002)与颈动脉斑块的易损性相关.结论 血清sCD40L、MMP-9、PAPP-A水平与颈动脉斑块的稳定性相关,较高的血清sCD40L、MMP-9、PAPP-A水平可能提示斑块易损或破裂.

abstractsObjectives To study the relationship between serum levels of some inflammatory markers and stability of carotid plaques in the patients with carotid plaques and evaluate the ability of each serum marker in identifying vulnerable carotid plaques.Methods The study included 65 consecutive patients with carotid plaques confirmed by imaging examinations from March 2008 to March 2010.All the patients were classified as stable plaques group (n =21 ) and unstable plaques group (n =44) according to the characteristic findings of the plaques in MRI such as the thickness of fibrous cap,the existence of large lipid core and the intra-plaque hemorrhage.The patients of unstable plaques group were further classified as unrupture plaques group ( n =29) and rupture plaques group ( n =15 ) according to the integrity of fibrous cap.Serum levels of soluble cluster of differentiation 40 ligand (sCD40L),matrix metalloproteinase 9 (MMP-9) and pregnancy-associated plasma protein A (PAPP-A) were determined by ELISA.Results Serum levels of sCD40L and MMP-9 in patients of unstable plaques group,unrupture plaques group and rupture plaques group were all significantly enhanced compared to individuals of stable plaques group ( SCD40L: X2 =6.45,12.04 and 16.23,P ＜ 0.01 ； MMP-9 ； F =2.55,5.10 and 4.69,P ＜ 0.05 ).Serum levels of PAPP-A in patients of unstable plaques group and rupture plaques group were all significantly enhanced compared to individuals of stable plaques group (X2 =11.71 and 13.55,P ＜ 0.05 ).Serum levels of PAPP-A in patients of rupture plaques group were significantly enhanced compared to individuals of unrupture plaques group ( x2 =13.19,P =0.000).sCD40L≥673.22 ng/L ( OR =22.47,95％ CI:2.11-239.81,P=0.010),MMP-9≥84.09 μg/L (OR=10.01,95％ CI:1.74-57.78,P=0.010) and PAPP-A ≥0.101 μg/L ( OR =14.29,95％ CI: 2.69-75.90,P =0.002) were all significantly correlated with the vulnerability of carotid plaques.Conclusions There appear to be a reltionship between the serum levels of sCD40L,MMP-9 and PAPP-A and the stahility of carotid plaques in patients with carotid plaques.High serum levels of the above-mentioned markers may indicate that the plaques were vulnerable or ruptured.