不同特点斑块对粥样硬化冠状动脉代偿性扩张的影响——在体血管内超声检测  

Influence of Plaques with Different Characteristics on the Compensatory Enlargement of Atherosclerotic Coronary ArteriesMeasured with in vivo Intravascular Ultrasound Imaging

作　　者：徐泽昌[1] 田军[1] 李鲁光[1] 徐少平[1] 张树林[1] 肖竞[1] 张桂珍[1] 崔吉君[1] 

机构地区：[1]北京军区总医院心内科

出　　处：《中华超声影像学杂志》1998年第5期268-271,共4页Chinese Journal of Ultrasonography

摘　　要：以血管内超声检测冠状动脉左主干１１支、左前降支１１支及左旋支３支，随机捕捉具粥样硬化斑块的血管段图像共３０帧。测量血管总面积，管腔面积，管腔最大、最小径，血管环病变范围，记录狭窄呈偏心或同心性，计算斑块面积及管腔狭窄程度。结果：血管总面积随斑块面积扩大而增加。狭窄程度＜５０％者斑块面积每增加１ｍｍ２，血管总面积扩大２．０９ｍｍ２。血管总面积与血管环病变范围呈正相关。偏心性狭窄者血管总面积与斑块面积呈明显正相关，同心性狭窄者两面积无相关。结论：冠状动脉随粥样硬化发生代偿性扩张；早期较轻狭窄、病变侵犯血管环范围大及斑块呈偏心生长则动脉代偿性扩张明显，否则扩张不明显；某些情况下（如早期较轻狭窄）动脉发生过度代偿性扩张。The compensatory enlargement of atherosclerotic human coronary arteries was validated by pathohistologic study, high frequency ultrasonography to epicardial coronary arteries and intravascular ultrasound imaging. But there were few reports on the relationship between the growth pattern of plaques, the range of the lesion or the percent stenosis of the lumen and the compensatory enlargement. Method: Intravascular ultrasound imaging was done to 11 patients with coronary heart disease. Eleven left main, 11 left anterior descending and 3 left circumflex coronary arteries were measured. Thirty images of the vessel segments having atherosclerotic plaques but not neighboring were caught using echo image analyzer. Then, total vessel area (TVA), lumen area(LA), maximal and minimal diameter of the lumen, and the arc length (degree) of the atherosclerotic lesions (ArcL) were measured, Plaque area(PA) and percent lumen stenosis(PLS) were then calculated. Results: TVA increased as PA expanded(r=0.68, P= 0.004 ). TVA of arteries with less than 50% stenosis had a significant corredlation to PA (n=18, r= 0.96 , P<0.00001), in addition, TVA increased 2.09 mm 2 for every 1 mm 2 increase in PA. A significant positive correlation was found between TVA and ArcL (r=0.53, P=0.003).In arteries with eccentric stenesis, TVA had significant positive correlation to PA (n=17, r=0.68, P=0.003), but no significant correlation was found in arteries with concentric stenosis. Conclusions: 1. Atheroscolerotic coronary arteries underwent compensatory enlargement. 2. The compensatory enlargement was more obvious in arteries with less stenosis, longer involvement in the vessel ring and eccentric stenosis. 3. Coronary arteries may over compensate in such situations as early,less stenosis.

关 键 词：介入性 超声描记术 冠状动脉 粥样硬化 

分 类 号：R541.4[医药卫生—心血管疾病]