<原著>冠動脈硬化の進展における血清リポカリン型プロスタグランディンD合成酵素(L-PGDS)の果たす役割 : 定量的冠動脈造影(QCA)と冠動脈内エコー(ICUS)を用いた検討

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Background : The extent and severity of coronary atherosclerosis significantly contribute to the mortality and mobility of coronary artery disease (CAD). 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. Methods : 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 ICUS. Results : 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 ICUS and coronary risk factors (PLA versus HDL ; r=-0.18,PLA versus LDL ; r=-0.09, 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). Conclusions : 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 ICUS. The assessment of L-PGDS would be useful to select highrisk patients with advanced coronary atherosclerosis out of usual patient population.
愛知医科大学の論文
2003-03-15

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