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化是预防冠心病患者心血管事件的一种有前景的临床策略。冠状动脉斑块和颈动脉斑块的不稳定性之间存在相关性，回声透亮的斑块被认为是易损斑块。我们检测了非高胆固醇血症患者应用他汀类药物强化降胆固醇治疗是否能有效改善超声结合背向散射积分(IBS)评估的易损斑块的回声清晰度。我们还检测了CD144-EMP(内皮衍生微粒)是否可作为血管内皮细胞(EC)功能障碍的特异性标记物，并确定循环中CD144-EMP水平是否可预测2型糖尿病(DM)患者的冠心病。结果：他汀组总胆固醇、低密度脂蛋白胆固醇(LDL-C)和高敏C反应蛋白显著降低。…回声能力显著增强他汀类药物组有更多的颈动脉斑块，而节食组没有发现，两组的斑块-IMT值均无明显回落。我们证明CD144阳性的微粒是选择性地从人EC中获得的。CD144-EMP水平反映了体外过氧化氢致内皮细胞损伤的程度和体内内皮依赖性冠脉血管扩张的受损程度。糖尿病患者血浆CD144-EMP水平明显高于非糖尿病患者。在糖尿病患者中，CD144-EMP水平的升高是与所有其他传统危险因素相比最显著的冠心病危险因素。结论：他汀类药物治疗在非高胆固醇血症冠心病患者中能迅速有效地增加易损斑块的回声，而不会使斑块大小退化。超声结合IBS对颈动脉斑块质量进行定量评估，有助于通过评估动脉粥样硬化的易损性来监测动脉粥样硬化病变。CD144阳性EMP存在于人血浆中，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，可能有助于识别糖尿病患者的冠心病风险增加。较少

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