Impact of Serum Level of Lipocalin-Type Prostaglandin D Synthase on Coronary Atherosclerosis

虽然冠心病危险因素包括高脂血症、高血压和糖尿病与冠状动脉粥样硬化有关，但危险因素的存在是否有足够的能力从普通患者人群中筛选出冠心病患者仍存在争议。虽然最近已知脂质运载蛋白-型-胰头素-D-合酶（L-PGDS）定位于人冠状动脉粥样硬化斑块中，但已发现血清L-PGDS主要来源于斑块。尽管冠状动脉内超声（ICUS）提供了冠状动脉壁病理学的独特断层信息，但ICUS评估的动脉粥样硬化斑块负荷与L-PGDS相关。我们前瞻性地对174例患者进行了定量血管造影（QCA）并测定了血清L-PGDS水平。冠状动脉正常42例，单支病变67例，双支病变49例，三支病变16例。比较四组间L-PGDS的变化。83例患者接受了IVUS冠状动脉介入治疗（PCI）。在174个L-PGDS中，NCA最低，TVD最高。随着冠状动脉粥样硬化程度的加重，L-PGDS水平逐渐升高。DVD组和TVD组血清L-PGDS水平显著高于NCA组（p<0.05）。在83例ICUS患者中，IVUS斑块面积（PLA）与冠状动脉危险因素（PLA与HDL ; r=-0.19，PLA与LDL ; r=-0.10，PLA与FBS ; r=-0.01）之间存在弱相关性，PLA与L-PGDS之间存在中度和显著相关性（r=0.51，p<0.001）。血清L-PGDS水平随冠状动脉病变程度加重而升高。虽然传统的冠状动脉危险因素显示ICUS冠状动脉粥样硬化的范围和严重程度的相关性较弱，但L-PGDS显示IVUS冠状动脉斑块负荷的相关性可接受。L-PGDS的检测有助于从普通人群中筛选出高危的晚期冠状动脉粥样硬化患者。

Although coronary risk factors including hyperlipidemia, hypertension and diabetes relate to coronary atherosclerosis, it still debates whether the presence of risk factors have enough ability to select the individual patient with CAD out of ordinary patient population. While lipocalin-type-prostaglandin-D-synthase (L-PGDS) has recently known to be localized in the human coronary atherosclerotic plaque, the serum L-PGDS has been found to mainly derive from the plaque. Whereas intracoronary ultrasound (ICUS) provides unique tomographic information of coronary mural pathology, atherosclerotic plaque burden assessed by ICUS would correlate to L-PGDS. We prospectively performed quantitative angiography (QCA) and measured serum L-PGDS level in 174 patients. Of the patients 42 had normal-coronary-artery (NCA), 67 single vessel disease (SVD), 49 double vessel disease (DVD) and 16 triple vessel disease (TVD). L-PGDS was compared among four groups. Eighty-three had coronary interventions (PCI) with IVUS. Of the 174 L-PGDS was the lowest in NCA and the highest in TVD. The L-PGDS level was gradually higher according to the severity of coronary atherosclerosis. The serum L-PGDS level in DVD and TVD was significantly higher than that in NCA (p<0.05). While a weak correlation was observed between plaque area (PLA) by IVUS and coronary risk factors (PLA versus HDL ; r=-0.19, PLA versus LDL ; r=-0.10, PLA versus FBS ; r=-0.01) in the 83 patients with ICUS, moderate and significant correlation was obtained between PLA and L-PGDS (r=0.51, p<0.001). Serum L-PGDS level significantly increased in proportion to the severity of CAD. Although conventional coronary risk factors indicated weak correlation to the extent and severity of coronary atherosclerosis by ICUS, L-PGDS showed acceptable correlation to coronary plaque burden by IVUS. The assessment of L-PGDS would be useful to select high-risk patients with advanced coronary atherosclerosis out of usual patient population.