Background: Acute coronary syndrome (ACS) is closely related to unstable plaques and secondary thrombosis. The inflammatory cells in plaques and their inflammatory products may be the cause for plaque instability and ruptures. The study aimed to disclose the changes of inflammatory factors including serum intracellular adhesion molecule-1 (ICAM-1), chitinase-3-like protein 1 (YKL-40), and lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with ACS and its clinical significance.
Methods: A total of 120 patients with coronary heart disease (CHD) were categorized into 2 groups: 69 with ACS and 51 with stable angina pectoris (SAP); 20 patients with chest pain and normal angiography served as a control group. The 120 patients with CHD were categorized into single-vessel disease group, double-vessel disease group, and three-vessel disease group based on the number of coronary artery stenosis. The severity of coronary artery stenosis was quantified based on coronary angiography using Gensini score. They were further divided into mild CHD group with its Gensini score <26 (n = 36), moderate CHD group with its Gensini score being 26-54 (n = 48) and severe CHD group with its Gensini score >54 (n = 36). Serum levels of ICAM-1, YKL-40, and Lp-PLA2 of different groups were determined by enzyme-linked immunosorbent assay. Correlation between ICAM-1, YKL-40, Lp-PLA2, and Gensini score was analyzed.
Results: The levels of serum inflammatory factors ICAM-1, YKL-40, and Lp-PLA2 were significantly higher in the ACS group than those in control group and SAP group (all P < 0.05); and compared with control group, no significant difference was observed in terms of the serum ICAM-1, YKL-40, and Lp-PLA2 levels in the SAP group (P > 0.05).The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, single-vessel disease group, double-vessel disease group, and three-vessel disease group (all P > 0.05). The levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not significantly different among control group, mild CHD group (Gensini score <26), moderate CHD group (Gensini score 26-54), and severe CHD group (Gensini score >54) (all P > 0.05). Nonparametric Spearman correlation analysis showed that the levels of serum ICAM-1, YKL-40, and Lp-PLA2 were not correlated with the Gensini score in CHD patients (r = 0.093, r = -0.149, and r = -0.085, all P > 0.05; respectively).
Conclusions: The serum levels of ICAM-1, YKL-40, and Lp-PLA2 were correlated with different clinical types of CHD, but not well correlated the severity and extent of artery stenosis, suggesting that ICAM-1, YKL-40, and Lp-PLA2 might be involved in occurrence of instability of atherosclerotic plaque, and might reflect the severity of CHD mostly through reflecting the plaque stability.
急性冠状动脉综合征与相关炎性因子的临床研究摘要背景：探讨急性冠状动脉综合征（ACS）患者相关炎性因子可溶性细胞间粘附分子（ICAM-1）、几丁质酶-3样蛋白-1（YKL-40）、脂蛋白相关磷脂酶A2(Lp-PLA2)的变化及其临床意义。 方法：入选冠心病（CHD）患者120例，分为ACS组69例和稳定型心绞痛（SAP）组51例。另选同期有胸痛症状冠状动脉造影正常的患者20例为对照组。再将120例CHD患者按病变血管支数分为单支病变组（45例）、双支病变组（38例）和三支病变组（37例）。采用Gensini评分系统评定冠脉血管病变狭窄程度，按Gensini积分分为轻度病变组（<26分）36例、中度病变组（26~54分）48例和重度病变组（>54分）36例。用酶联免疫吸附试验（ELISA）法分别检测血清ICAM-1、YKL-40、Lp-PLA2水平，对各组进行比较分析，并分别与Gensini积分进行相关性分析。 结果：与对照组和SAP组相比，ACS组血清炎性因子ICAM-1、YKL-40、Lp-PLA2均明显升高（P均<0.05），SAP组与对照组比较，ICAM-1、YKL-40、Lp-PLA2差异均无统计学意义（P均>0.05）。单支病变组、双支病变组、三支病变组血清炎性因子ICAM-1、 Lp-PLA2、 YKL-40差异均无统计学意义（P均> 0.05）。轻度病变组、中度病变组和重度病变组血清炎性因子ICAM-1 、Lp-PLA2、 YKL-40差异均无统计学意义（P均> 0.05）。非参数Spearman相关分析显示血清炎性因子ICAM-1 、YKL-40、Lp-PLA2水平与Gensini积分均无明显相关性（r=0.093，r=-0.149, r=-0.085，P均>0.05）。 结论：血清炎性因子ICAM-1、YKL-40、Lp-PLA2与CHD的临床类型有关，ACS组患者ICAM-1、YKL-40、Lp-PLA2较SAP组和对照组明显升高，提示三种炎症因子可能参与斑块不稳定性的发生，成为预测CHD患者发生ACS风险和病情严重程度的临床指标。CHD患者血清炎性因子ICAM-1、YKL-40、Lp-PLA2水平与冠状动脉病变狭窄的范围和程度相关性不明显，提示其反映冠心病患者病情严重程度主要与反映斑块的稳定性有关。.
Keywords: Acute Coronary Syndrome; Chitinase-3-Like Protein 1; Coronary Heart Disease; Intracellular Adhesion Molecule-1; Lipoprotein-Associated Phospholipase A2.