应用血管内视镜对急性心肌梗死患者血管病变的研究  

The observation of culprit vessels in patients with acute myocardial infarction by coronary angioscopy

作　　者：马淑梅[1] 孙志军[1] 水野杏一[2] 

机构地区：[1]中国医科大学附属第二医院心内科,辽宁沈阳110004 [2]日本医科大学附属千叶北总病院

出　　处：《中国临床医学影像杂志》2006年第6期324-326,共3页Journal of China Clinic Medical Imaging

摘　　要：目的:应用冠状动脉血管内视镜技术对ST段抬高和非ST段抬高的急性心肌梗死病人的罪犯血管进行观察,为研究急性心肌梗死的发生提供临床病理依据。方法:选择ST段抬高AMI(STMI)28例,非ST段抬高AMI(NSTMI)18例,在进行急诊冠状动脉介入性检查和治疗的同时,对罪犯血管进行血管镜检查。结果:STMI组和NSTMI组的罪犯血管内均可见到黄色斑块,其中NSTMI组中观察到斑块破裂者明显高于STMI组(88.89%vs57.14%,P=0.022)。STMI组中观察到红色或混合性血栓者明显高于NSTMI组(92.85%vs55.56%,P=0.003),并且前者以闭塞性血栓为主(78.57%vs11.11%,P<0.0001),后者以非闭塞性的壁在性血栓为主(44.44%vs14.29%,P=0.054)。结论:黄色不稳定性斑块破裂及其伴随的血栓形成,是引起AMI的病理基础;STMI以红色或混合性闭塞性血栓为主,而NSTMI则以非闭塞性的附壁血栓为主。因此,在黄色斑块破裂之前采取何种治疗措施使其稳定化,是预防AMI的关键。Objective： To provide the clinical pathological basis for AMI by means of observation culprit vessels in acute myocardial infarction（AMI） patients with or without ST segment elevation by coronary angioscopy. Methods： Twenty-eight cases of AMI with ST elevation（STMI） and 18 cases AMI without ST elevation（NSTMI） were included. The criminal vessels were investigated by coronary angioscopy when these patients were accepting coronary interventional examination and therapy. Results： ①Yellow plaque was detected in all the culprit vessels of AMI patients. ②There were a higher rate of plaque rupture detection in the group of NSTMI than that of STMI （88.89% vs 57.14% respectively, P=0.022）. ③The red or mixed plaque was more common in STMI group than in NSTMI（92.85% vs 55.56% respectively, P=0.003）. Meanwhile the occlusive thrombus was more common in STMI group（78.57% vs 11.11% respectively, P〈0.0001） while the non-occlusive thrombus was more common in NSTMI group（44.44% vs 14.29% respectively, P=0.054）. Conclusion： Rupture of unstable yellow plaque and its accompanied thrombosis was the pathological basis of AMI. Red or unstable plaque was predominant in STMI while non-occlusive plaque was mostly seen in NSTMI. Thus, to stabilize the yellow plaque before its rupture is the key point to prevent the onset of AMI.

关 键 词：心肌梗塞 血管内窥镜 

分 类 号：R542.22[医药卫生—心血管疾病] R730.49[医药卫生—内科学]