控制危险因素对无症状性冠状动脉内膜病变防治的研究  

Prevention of asymptomatic coronary intimal lesion by controlling the risk factors of coronary heart disease

作　　者：马淑梅[1] 李铁军[1] 耿宁[1] 邹德玲[1] 李晓东[1] 孙英贤[1] 水野杏一[2] 

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

出　　处：《中国实用内科杂志：临床前沿版》2006年第8期1248-1251,共4页

基　　金：辽宁省教育厅基金项目(05L580)

摘　　要：目的探讨通过对冠心病的危险因素进行干预和控制对无症状性冠状动脉内膜病变发生的预防作用。方法对2004年1月至12月日本医科大学附属千叶北总病院收治的120例陈旧性心肌梗死和稳定型心绞痛患者的非罪犯血管应用冠状动脉血管内视镜技术进行观察,探讨黄色斑块、斑块破裂和(或)血栓形成等内膜病变与高血压、糖尿病、高低密度脂蛋白胆固醇(LDL-C)血症病人中血压、血糖和LDL-C等水平之间的关系。结果在120例患者155支非罪犯血管内,观察到内膜病变者80例(66.67%),非内膜病变者40例(33.33%),在内膜病变组中观察到单纯黄色斑块者30例(25.00%),复杂性斑块者50例(41.67%)。120例患者中合并高血压者69例(57.50%),合并高LDL-C血症患者79例(65.83%),合并2型糖尿病患者40例(33.33%)。血压<140/90mmHg(1mmHg=0.133kPa)者中观察到复杂性斑块者低于血压≥140/90mmHg者(P<0.05);2型糖尿病患者中血糖控制良好者内膜病变和斑块破裂的发生率均低于控制不良者(P<0.05);高LDL-C血症病人中LDL-C水平控制在2.60mmol/L以下者在各种内膜病变发生情况与≥2.60mmol/L者相比均有减少趋势,但差异无统计学意义(P>0.05)。结论积极有效治疗高血压、糖尿病和高LDL-C血症,使其控制在理想水平,可以有效地预防粥样斑块的破裂,从而预防急性冠状动脉综合征(ACS)的发生。Objective To explore the prevention of asymptomatic coronary intimal lesion by controlling the risk factors of coronary heart disease （CHD）. Methods The relationship between the intimal lesion （ such as yellow plaque, plaque rupture and/or thrombus formation） and risk factors （ such as hypertension, diabetes, high blood LDL - C, blood pressure and blood sugar in patients with high blood LDL - C） was investigated in the non - culprit vessels of 120 patients with old myocardial infarction and stable angina pectoris by applying coronary angioscopy. Results Totally 155 non - culprit vessels in 120 patients were explored and the following findings were observed： （ 1 ） There are 80 cases （66. 67% ） of intimal lesion, 40 cases （33.33%） without intimal lesion. （2） In the group with intimal lesion, the simple yellow plaque was observed in 30 cases （25.00%） and complex plaque in 50 cases. （3） In 120 patients, hypertension was observed in 69 cases （57.50%）, high blood LDL- C in 79 cases （65.83%） and type 2 diabetes in 40 cases （33.33%）. （4） The complex plaques was less common in patients whose BP was less than 140/90 mm Hg than in patients more than 140/90 mm Hg （ P 〈 0. 05）. （5） In patients with type 2 diabetes, intimal lesion and plaque rupture was less common in patients whose blood sugar was well controlled than in patients not well controlled. （ P 〈0. 05 ）. （6） There was a decreasing tendency of intimal lesion when the LDL - C was controlled under 2. 60 mmol/L in the patients with high blood LDL - C, but there was no significant difference （P 〉 O. 05）. Conclusion The plaque rupture can be well prevented which can reduce the incidence of ACS if the high blood pressure, high blood sugar, high LDL - C are controlled to an ideal level.

关 键 词：血管内视镜 无症状性内膜病变 高血压 糖尿病 LDL—C 

分 类 号：R5[医药卫生—内科学]