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临床中,动脉粥样易损斑块破裂所致继发性血栓形成是造成心脑血管缺血事件的主要原因。很多研究显示,栓塞所致的突发心脑血管事件与病变管腔的狭窄程度不成正比,斑块的稳定性(组成成分)在一定程度上较管腔狭窄程度在预测冠心病患者急性心脑血管事件风险方面的准确率更高[1]。易损斑块可通过影像学检查(如血管内造影、多层螺旋CT等)进行筛查,另外也有研究证实易损斑块内有大量炎症物质,其检出可反映斑块的易损程度。有研究显示,冠状动脉、颈动脉粥样硬化是脑血管发生缺血事件的重要危险因素[2],通过观察心脏和颈动脉狭窄程度可预测脑血管病的发生,因此利用影像学方法结合血清炎性因子检测可提高对易损斑块的检出率,全面准确地发现和评价动脉粥样硬化的情况及程度,对于预防和治疗心脑血管疾病有着重要的意义。
心脑血管粥样易损斑块的诊断及研究进展
Diagnosis and research progress of atherosclerotic vulnerable plaque in the heart and brain
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摘要: 动脉粥样硬化易损斑块是指稳定性差及存在血栓形成倾向的斑块,急性心脑血管缺血事件主要是由易损斑块的破裂和继发血栓形成所致。研究表明,冠状动脉粥样硬化常与头颈动脉粥样硬化密切相关且常同时发生,一些炎症因子在发病早期即可在外周血中被检测到。诊断易损斑块的临床手段有很多,笔者就冠状动脉、头颈部血管粥样易损斑块的影像学诊断及相关血清炎症因子的研究现状与前景进行综述。Abstract: Atherosclerotic vulnerable plaque refers to the plaque with poor stability and tendency of thrombosis, and acute cardiovascular and cerebrovascular ischemia evens are mainly caused by the rupture of vulnerable plaque and secondary thrombosis. Studies have shown that coronary atherosclerosis is closed related to and often occurs simultaneously with head and neck atherosclerosis, and some inflammatory factors can be detected in peripheral blood at the early stage of the disease. There are many clinical method for the diagnosis of vulnerable plaque. In this paper, the imaging diagnosis of atherosclerotic plaque of coronary arteries and head and neck as well as the research status and prospects of related inflammatory factors are summarized as follows.
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Key words:
- Plaque, atherosclerosis /
- Angiocardiography /
- Inflammatory cytokines
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[1] 李红. 双源螺旋CT诊断冠脉易损斑块的应用价值[J]. 中国CT和MRI杂志, 2016, 14(1): 42−45. DOI: 10.3969/j.issn.1672−5131.2016.01.014.
Li H. The application velue of DSCT in the diagnosis of coronary vunerable plaques[J]. Chin J CT MRI, 2016, 14(1): 42−45. DOI: 10.3969/j.issn.1672−5131.2016.01.014.[2] Nakamura T, Tsutsumi Y, Shimizu Y, et al. Ulcerated Carotid Plaques with Ultrasonic Echolucency Are Causatively Associated with Thromboembolic Cerebrovascular Events[J]. J Stroke Cerebrovasc Dis, 2013, 22(2): 93−99. DOI: 10.1016/j.jstrokecerebrovasdis.2011.06.015. [3] Valgimigli M, Agostoni P, Serruys PW. Acute coronary syndromes: an emphasis shift from treatment to prevention; and the enduring challenge of vulnerable plaque detection in the cardiac catheterization laboratory[J]. J Cardiovasc Med (Hagerstown), 2007, 8(4): 221−229. DOI: 10.2459/01.JCM.0000263487.36993.37. [4] Gauss S, Achenbach S, Pflederer T, et al. Assessment of coronary artery remodelling by dual-source CT: a head-to-head comparison with intravascular ultrasound[J]. Heart, 2011, 97(12): 991−997. DOI: 10.1136/hrt.2011.223024. [5] Maurovich-Horvat P, Ferencik M, Voros S, et al. Comprehensive plaque assessment by coronary CT angiography[J]. Nat Rev Cardiol, 2014, 11(7): 390−402. DOI: 10.1038/nrcardio.2014.60. [6] Otsuka K, Fukuda S, Tanaka A, et al. Napkin-Ring Sign on Coronary CT Angiography for the Prediction of Acute Coronary Syndrome[J]. JACC Cardiovasc Imaging, 2013, 6(4): 448−457. DOI: 10.1016/j.jcmg.2012.09.016. [7] 张晓东, 唐秉航, 李芳云, 等. 256层螺旋CT低剂量心脑血管联合成像初步研究[J]. 中华放射学杂志, 2011, 45(11): 1008−1012. DOI: 10.3760/cma.j.issn.1005−1201.2011.11.004.
Zhang XD, Tang BH, Li FY, et al. Low dose 256-slice spiral CT of coronary combined with carotid and cerebrovascular angiography[J]. Chin J Radiol, 2011, 45(11): 1008−1012. DOI: 10.3760/cma.j.issn.1005−1201.2011.11.004.[8] Leschka S, Stolzmann P, Desbiolles L, et al. Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience[J]. Eur Radiol, 2009, 19(12): 2896−2903. DOI: 10.1007/s00330−009−1618−9. [9] 韩洋, 韩瑞娟, 陈国强, 等. Flash双源CT迭代重建80 kV低剂量冠状动脉CT成像的临床应用[J/OL]. 中华诊断学电子杂志, 2017, 5(1): 1−7[2018-11-11]. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhzdxdzzz201701001. DOI: 10.3877/cma.j.issn.2095-655X.2017.01.001.
Han Y, Han RJ, Chen GQ, et al. Clinical application of electrocardiogram-triggered high-pitch dual-source coronary CT angiography at 80 kV low radiation dose integrated iterative reconstruction technology[J/OL]. Chin J Diagnostics (Electronic Edition), 2017, 5(1): 1-7[2018-11-11]. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhzdxdzzz201701001. DOI: 10.3877/cma.j.issn.2095-655X.2017.01.001.[10] 孙凯, 韩瑞娟, 王利军, 等. 大螺距双源CT心脏与头颈血管一站式联合扫描的可行性[J]. 中国医学影像技术, 2014, 30(1): 136−140. DOI: 10.13929/j.1003−3289.2014.01.013.
Sun K, Han RJ, Wang LJ, et al. Feasibility of high-pitch dual-source CT coronary combined with carotid and cerebrovascular angiography[J]. Chin J Med Imaging Technol, 2014, 30(1): 136−140. DOI: 10.13929/j.1003−3289.2014.01.013.[11] 刘淑蓉, 陈国强, 郑亮, 等. CT心脑血管一体化成像的图像质量评价[J]. 国际放射医学核医学杂志, 2018, 42(5): 389−396. DOI: 10.3760/cma.j.issn.1673−4114.2018.05.001.
Liu SR, Chen GQ, Zheng L, et al. Evaluation of the image quality of integrated imaging in coronary combined with carotid and cerebrovascular computed tomography angiography[J]. Int J Radiat Med Nucl Med, 2018, 42(5): 389−396. DOI: 10.3760/cma.j.issn.1673−4114.2018.05.001.[12] Voudris KV, Chanin J, Feldman DN, et al. Novel Inflammatory Biomarkers in Coronary Artery Disease: Potential Therapeutic Approaches[J]. Curr Med Chem, 2015, 22(22): 2680−2689. DOI: 10.2174/0929867322666150420124427. [13] 管雅琳, 于长申, 张莹, 等. 急性缺血性脑血管病患者血清ox-LDL及PAPP-A水平变化及临床意义[J]. 中国老年学杂志, 2016, 36(18): 4482−4483. DOI: 10.3969/j.issn.1005−9202.2016.18.038.
Guan YL, Yu CS, Zhang Y, et al. Changes of serum ox-LDL and PAPP-A levels in patients with acute ischemic cerebrovascular disease and its clinical significance[J]. Chin J Gerontol, 2016, 36(18): 4482−4483. DOI: 10.3969/j.issn.1005−9202.2016.18.038.[14] Viola M, Karousou E, D'Angelo ML, et al. Extracellular Matrix in Atherosclerosis: Hyaluronan and Proteoglycans Insights[J]. Curr Med Chem, 2016, 23(26): 2958−2971. DOI: 10.2174/0929867323666160607104602. [15] Reimann C, Brangsch J, Colletini F, et al. Molecular imaging of the extracellular matrix in the context of atherosclerosis[J]. Adv Drug Deliv Rev, 2017, 113: 49−60. DOI: 10.1016/j.addr.2016.09.005. [16] Wang MY, Kim SH, Monticone RE, et al. Matrix metalloproteinases promote arterial remodeling in aging, hypertension, and atherosclerosis[J]. Hypertension, 2015, 65(4): 698−703. DOI: 10.1161/HYPERTENSIONAHA.114.03618. [17] Xu R, Yin X, Xu W, et al. Assessment of carotid plaque neovascularization by contrast-enhanced ultrasound and high sensitivity C-reactive protein test in patients with acute cerebral infarction: a comparative study[J]. Neurol Sci, 2016, 37(7): 1107−1112. DOI: 10.1007/s10072−016−2557−2. [18] Matsuo Y, Kubo T, Okumoto Y, et al. Circulating malondialdehyde-modified low-density lipoprotein levels are associated with the presence of thin-cap fibroatheromas determined by optical coherence tomography in coronary artery disease[J]. Eur Heart J Cardiovasc Imaging, 2013, 14(1): 43−50. DOI: 10.1093/ehjci/jes094. [19] Koyama K, Yoneyama K, Mitarai T, et al. Association between inflammatory biomarkers and thin-cap fibroatheroma detected by optical coherence tomography in patients with coronary heart disease[J]. Arch Med Sci, 2015, 11(3): 505−512. DOI: 10.5114/aoms.2015.52352. [20] Zhang L, Cheng HL, Yue YX, et al. TUG1 knockdown ameliorates atherosclerosis via up-regulating the expression of miR-133a target gene FGF1[J]. Cardiovasc Pathol, 2018, 33: 6−15. DOI: 10.1016/j.carpath.2017.11.004. [21] Li H, Liu X, Zhang L, et al. LncRNA BANCR facilitates vascular smooth muscle cell proliferation and migration through JNK pathway[J/OL]. Oncotarget, 2017, 8(70): 114568−114575 [2018-11-11]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777714/. DOI: 10.18632/oncotarget.21603. [22] Molina E, Chew GS, Myers SA, et al. A Novel Y-Specific Long Non-Coding RNA Associated with Cellular Lipid Accumulation in HepG2 Cells and Atherosclerosis-related Genes[J/OL]. Sci Rep, 2017, 7(1): 16710 [2018-11-11]. https://www.ncbi.nlm.nih.gov/pubmed/29196750. DOI: 10.1038/s41598-017-17165-9. [23] Hu GQ, Tang QS, Sharma S, et al. Expression and regulation of intergenic long noncoding RNAs during T cell development and differentiation[J]. Nat Immunol, 2013, 14(11): 1190−1198. DOI: 10.1038/ni.2712. [24] Xia F, Dong FL, Yang Y, et al. Dynamic Transcription of Long Non-Coding RNA Genes during CD4+ T Cell Development and Activation[J/OL]. PLoS One, 2014, 9(7): e101588 [2018-11-11]. https://www.ncbi.nlm.nih.gov/pubmed/25003630. DOI: 10.1371/journal.pone.0101588. [25] Liu CY, Zhang YH, Li RB, et al. LncRNA CAIF inhibits autophagy and attenuates myocardial infarction by blocking p53-mediated myocardin transcription[J/OL]. Nat Commun, 2018, 9(1): 29 [2018-11-11]. https://www.ncbi.nlm.nih.gov/pubmed/29295976. DOI: 10.1038/s41467-017-02280-y.
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