Assessment and Evaluation of Vascular Vulnerability in Patients with Atherosclerosis: Clinical Examination and Application

目的：动脉粥样硬化斑块稳定是预防冠状动脉疾病（CAD）患者心血管事件的一种有前景的临床策略。冠状动脉和颈动脉斑块的不稳定性存在相关性，泛光斑块被认为是易损斑块。我们研究了他汀类药物对非高胆固醇患者的强化降胆固醇治疗是否能有效改善易损斑块的回波，超声综合后向散射（IBS）分析评估了易损斑块。我们还研究了CD144-EMP（内皮源性微粒）是否可作为内皮细胞（EC）功能障碍的特异性标志物，并确定循环CD144-EMP的血浆水平是否可预测2型糖尿病（DM）患者的CAD。结果：他汀类药物组总胆固醇、低密度脂蛋白胆固醇（LDL-C）和高敏c反应蛋白显著降低。他汀类药物组颈动脉斑块增多，饮食组无明显变化，两组斑块- imt值均无明显下降。我们证明了cd144阳性微粒是选择性地从人EC中获得的。CD144-EMP水平反映体外过氧化氢诱导的EC损伤程度和体内内皮依赖性冠状动脉血管舒张功能的损害程度。与非糖尿病患者相比，糖尿病患者血浆CD144-EMP水平显著升高。在糖尿病患者中，与所有其他传统危险因素相比，CD144-EMP水平升高是CAD最重要的危险因素。结论：在非高胆固醇血症的冠心病患者中，他汀类药物治疗可快速有效地增加易损斑块的回声性，而不减少斑块大小。通过IBS超声定量评估颈动脉斑块质量，通过评估动脉粥样硬化的易损性，对监测动脉粥样硬化病变有临床意义。人血浆中存在cd144阳性的EMP，血浆CD144-EMP水平可作为EC功能障碍和/或损伤的临床特异性和定量标志物。测量CD144-EMP，通过提供EC功能障碍的定量评估，可能有助于识别冠心病风险增加的DM患者。少

OBJECTIV ES: Atherosclerotic plaque stabilization is a promising clinical strategy to prevent cardiovascular events in patients with coronary artery disease (CAD). There is a correlation between coronary and carotid plaque instability, and echolucent plaques are recognized as vulnerable plaques. We examined whether intensive cholesterol-lowering therapy with statins in nonhypercholesterolemic patients is effective in improving echolucency of vulnerable plaques assessed by ultrasound with integrated backscatter (IBS) analysis.We also examine whether CD144-EMP (endothelium derived microparticles) is useful as a specific marker of endothelial cell (EC) dysfunction and to determine whether plasma levels of circulating CD144-EMP predicted CAD in patients with type 2 diabetes mellitus (DM).RESULTS : Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein were significantly decreased in the statin group. Significant increases of echogenicity of … More carotid plaques were noted in the statin grcup but not in the diet group without significant regression of plaque-IMT values in both groups. We demonstrated that CD144-positive microparticles were derived selectively from human EC. The levels of CD144-EMP reflected the degree of in vitro hydrogen-peroxide-induced EC injury and impairment of in vivo endothelium-dependent coronary vasodilation. Plasma CD144-EMP levels were increased significantly in DM patients compared with patients without DM. In DM patients, the elevated levels of CD144-EMP were the most significant risk factor for CAD relative to all other traditional risk factors.CONCLUSIONS: Statin therapy is rapidly effective in increasing echogenicity of vulnerable plaques without regression of plaque size in nonhypercholesterolemic patients with CAD. Quantitative assessment of carotid plaque quality by ultrasound with IBS is clinically useful for monitoring atherosclerotic lesions by evaluating vulnerability of atheroma. The CD144-positive EMP exist in human plasma, and plasma CD144-EMP levels can be a clinically specific and quantitative marker of EC dysfunction and/or injury. Measurement of CD144-EMP, by providing a quantitative assessment of EC dysfunction, may be useful for identifying DM patients with increased risk of CAD. Less