糖尿病患者冠状动脉粥样硬化病变的虚拟组织学血管内超声研究  

Virtual histology intravascular ultrasound assessment of coronary atherosclerotic plaques in diabetic patients

作　　者：刘媛[1] 刘学波[1] 钱菊英[1] 李晨光[1] 戴宇翔[1] 黄浙勇[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,200032

出　　处：《中华心血管病杂志》2010年第6期497-502,共6页Chinese Journal of Cardiology

基　　金：2007-2009年度卫生部部属（管）医院临床学科重点项目;＂十一五＂国家科技支撑计划子课题（2006BAI01A02）

摘　　要：目的 使用虚拟组织学血管内超声（virtual histology intravascular ultrasound,VH-IVUS）评价2型糖尿病患者冠状动脉粥样硬化斑块的组织成分和形态特征.方法 在2008年9月至2009年3月,前瞻性连续收集冠状动脉造影提示的、三支主要血管中直径狭窄≥50%的原位粥样斑块病变,进行灰阶血管内超声以及二维和体积法VH-IVUS分析.根据患者临床资料分为糖尿病（DM）组22例（39个病变）和非DM组46例（69个病变）.结果 在最小管腔面积处,DM组斑块的坏死核心（19.4%±1.2%比15.1%±1.1%,P=0.015）和钙化成分（15.2%±1.6%比10.7%±1.1%,P=0.016）较非DM组更多,而纤维组织（56.7%±2.3%比64.8%±1.8%,P=0.007）更少;同样,体积法VH-IVUS发现DM组的坏死核心体积（21.3%±1.3%比16.5%±1.1%,P=0.008）和钙化组织体积（16.6%±1.4%比11.3%±1.1%,P=0.003）更大,而纤维组织体积（55.1%±2.1%比63.9%±1.8%,P=0.003）更小.此外,DM组薄帽纤维粥样硬化斑块的发生率（69.2%）较非DM组（42.O%）更高（P=0.009）.然而,斑块重构系数和正性重构发生率在两组差异均无统计学意义.结论 相对于非DM患者,DM患者冠状动脉狭窄性粥样斑块的坏死和钙化组织含量更多,易损斑块也更多见.Objective To evaluate the components and characteristics of coronary atherosclerotic plaques in type 2 diabetic patients using virtual histology intravascular ultrasound （VH-IVUS）. Methods In vivo atherosclerotic plaques （ over 50% angiographic diameter stenosis ） of the three main coronary arteries were analyzed by gray-scaled IVUS with planar and volumetric VH-IVUS in consecutive patients examined between September 2008 and March 2009. Patients were divided into two groups： diabetic mellitus （DM） group with 22 patients （39 lesions） and non-DM group with 46 patients （69 lesions）. Results At the minimal lumen area （MLA） site, the percentage of NC （necrotic core） area （19.4% ± 1.2% vs.15.1% ± 1.1%, P =0. 015） and dense calcium （DC） area （15.2% ± 1.6% vs. 10. 7% ± 1.1%, P =0. 016） were significantly larger while fibrotic tissue （FT） area （56. 7% ±2. 3% vs. 64. 8% ± 1.8%, P =0. 007） was smaller in DM group than in non-DM group. Likewise, volumetric VH-IVUS analysis showedthat the percentage of NC volume （21.3% ± 1.3% vs. 16. 5% ± 1.1%, P = 0. 008） and DC volume （16.6% ±1.4% vs. 11.3% ±1.1%, P=0.003） were significantly larger while FT volume （55. 1% ±2. 1% vs. 63.9% ± 1.8%, P =0.003） was significantly smaller in DM group than in non-DM group.Moreover, significantly higher incidence of VH-TCFA （thin-cap fibroatheromas） was evidenced in the DM group than in the non-DM group （69. 2% vs. 42. 0%, P =0. 009）. However, the remodeling index and the positive remodeling frequency were similar between the 2 groups. Conclusion Incidence of necrotic core, dense calcium plaque and vulnerable plaques in stenotic lesions was higher in DM patients than in non-DM patients.

关 键 词：糖尿病 2型 冠状动脉硬化 超声检查 介入性 

分 类 号：R541.4[医药卫生—心血管疾病]