急性冠脉综合征冠脉病变的血管内超声研究  

An intravascular ultrasound research about the culprit lesions in acute coronary syndrome

作　　者：王青海[1] 徐会圃[1] 刘现亮[1] 张明哲[2] 刘长梅[1] 王东[1] 李宗清[1] 李景森[1] 程艳丽[1] 张静[1] 

机构地区：[1]滨州医学院附属医院,滨州市256603 [2]胜利油田中心医院

出　　处：《滨州医学院学报》2009年第2期84-86,共3页Journal of Binzhou Medical University

基　　金：山东省优秀中青年科学家科研奖励基金项目(2006BS03069)

摘　　要：目的探讨急性冠脉综合征冠状动脉罪犯病变的血管内超声(IVUS)特点。方法对35例稳定型心绞痛(SA)患者和49例急性冠脉综合征(ACS,包括急性心肌梗死和不稳定型心绞痛)患者进行冠状动脉造影(CAG)检查,并应用IVUS观察冠脉罪犯病变处的粥样硬化斑块的性质,同时测量血管外弹力膜面积(EEA)、管腔面积(LA),计算斑块面积(PA)、斑块负荷、偏心指数(EI),并观察血管重构情况。结果ACS患者冠脉病变处以软斑块为主(69.4%,34/49),SA患者冠脉病变处以硬斑块为主(77.1%,27/35),差异有统计学意义(P<0.05),其中ACS组不稳定斑块、内膜破裂和血栓形成病变占总病变的57.2%,与SA组(8.6%)相比具有显著差异性(P<0.01);同时两组患者斑块面积[(11.26±3.92)mm2vs(9.43±3.98)mm2],斑块负荷[(65.67±11.74)%vs(57.34±11.18)%],偏心指数(0.33±0.22 vs 0.59±0.24)相比差异亦具有显著性(P<0.01);而且,ACS患者主要以正性重构为主(59.2%),而SA患者主要以负性重构为主(57.1%),二者均有统计学差异(P=0.000,P=0.002)。结论在ACS组不稳定斑块及内膜破裂、血栓形成、血管正性重构发生率明显高于SA组,IVUS检查是在体观察粥样斑块的良好手段,并可以指导治疗策略。Objective To investigate the characteristic of plaques through intravascular ultrasound. Methods Thirthy-five patients with stable angina pectoris （ SA ） and fourty-nine patients with acute coronary syndrome （ACS） （ included acute myocardial infarction and unstable pectoris） were examined by coronary arteriography（CAG） and intravascular ultrasound （IVUS）. We studied the culprit lesions about the characteristic of the plaque, measured the external elastic membrane cross-sectional area and lumen cross-sectional area,calculated the plaque area, plaque burden, eccentricity index , and examind the remodeling index. Results Soft plaques were dominant in ACS patients （69.4% ,34/49） ,and hard plaques were dominant in SA patients[77. 1% （27/35） ,P 〈0.05]. The proportion of instability plaues, ruptured membranes,thrombosis is higher in ACS group. Also, plaque area, plaque burden and eccentricity index were all significantly larger in ACS patients than in SA patients （ all P 〈 0. 05 ）. Positive remodeling was more frequent in ACS patients than in SA patients, whereas negative remodeling was more frequent in SA patients （ P 〈 0. 05 ）. Conclusion In ACS group, the incidence of plaque vulnerability and rupture, thrombosis, positive remodeling were higher than in SA group. Intravascular ultrasound is a better method to identify the quality of plaque ,which can guide the therapy.

关 键 词：冠状动脉粥样硬化 心肌梗死 不稳定型心绞痛 超声检测 

分 类 号：R541[医药卫生—心血管疾病]