急性冠脉综合征病变的血管内超声研究  

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

作　　者：徐会圃[1] 王青海[1] 刘长梅[1] 刘现亮[1] 张明哲[2] 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心内科,山东滨州256603 [2]胜利油田中心医院

出　　处：《中国老年学杂志》2009年第21期2705-2707,共3页Chinese Journal of Gerontology

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(ACS)冠状动脉粥样斑块病变的血管内超声(IVUS)特点。方法应用IVUS观察35例稳定型心绞痛(SA)和49例急性冠脉综合征(包括急性心肌梗死和不稳定型心绞痛)患者冠脉病变处的粥样硬化斑块的特征。结果ACS组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组不稳定斑块和斑块破裂,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、斑块负荷、偏心指数相比差异亦具有显著性(P<0.01);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<0.01)。结论ACS组软斑块及斑块破裂、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 the characteristic of plaques through intravascular ultrasound. Methods Tbirthy-five patients with stable angina pectoris（SA） and fourty-nine patients with acute coronary syndrome （ACS） （including acute myocardial infarction and unstable pectoris ） were examined by intravascular ultrasound （ IVUS ） to study the culprit lesions about the characteristic of the plaque. 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 was higher in ACS group. Also, plaque area, plaque burden and eccentricity index were all significantly larger in ACS patients than those of 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 ）. Conclusions In ACS group, the incidence of soft plaque and plaque rupture, thrombosis, positive remodeling are higher than those of the SA group, lntravascular 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 心绞痛 不稳定型 超声检测 

分 类 号：R541.4[医药卫生—心血管疾病]