ST段抬高心肌梗死患者中IRAs血栓性病变的空间分布以及分叉处斑块的破裂机制  

The space distribution of thrombotic lesion in IRAs and mechanism of bifurcation lesion rupture in patients with STEMI

作　　者：张俊霞[1] 陈绍良[1] 叶飞[1] 张俊杰[1] 田乃亮[1] 刘志忠[1] 

机构地区：[1]南京医科大学附属南京市第一医院心内科,江苏南京210006

出　　处：《西安交通大学学报（医学版）》2011年第2期193-195,200,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的因为血管分叉处斑块的稳定性难以判定,本研究观察急性ST段抬高心肌梗死(STEMI)人群中梗死相关动脉(IRAs)血栓性病变与血管分叉的关系,从斑块破裂后的结局探索斑块破裂的规律。方法 2003年6月至2009年11月连续274例STEMI患者,冠脉造影(CAG)后剔除6例支架内血栓及1例伴有主动脉夹层的患者,根据CAG所见IRAs血栓性病变是否累及血管分叉处,将267例患者分为分叉处病变组(n=32例)与非分叉处病变组(n=235例)。结果分叉处血栓性病变的发生率为11.99%。与非分叉处病变组相比,分叉处病变组糖尿病患病率较少(12.5%vs.18.30%,P<0.01),梗死前心绞痛史更常见(62.5%vs.41.28%,P<0.05),前壁心肌梗死更常见(81.25%vs.51.06%,P<0.01),前降支(LAD)是分叉处血栓性病变的好发血管(81.25%vs.50.21%,P<0.01)。在分叉处病变组,68.75%的血栓性病变发生在分叉上游。结论 STEMI患者的IRAs中,血管分叉处斑块破裂的发病率相对较低,多见于LAD与对角支(D)分叉上游。Objective Little is known about plaque stability of bifurcation lesions.The information of bifurcation plaque stability can be obtained from the consequence of plaque rupture in acute ST elevation myocardial infarction（STEMI） patients by analyzing the relationship between thrombotic lesion and side branch in infarct-related arteries（IRAs）.Methods Of 274 consecutive patients with STEMI recommended for coronary angiography from June 2003 to November 2009,6 patients with in-stent thrombosis and 1 patient with concurrent aortic dissection were excluded.The remaining 267 patients were divided into bifurcation（n=32） and non-bifurcation（n=235） groups according to the involvement of side branch with thrombotic lesion.Results The incidence of thrombotic lesion at the site of bifurcation was 11.99%.Compared with those in non-bifurcation group,fewer patients in bifurcation group had diabetes mellitus（12.5% vs.18.30%,P0.01）,more had pre-infarct angina（62.5% vs.41.28%,P0.05）,and more had anterior wall myocardial infarction（81.25% vs.51.06%,P0.01）.The left anterior descending artery（LAD） dominated the susceptible vessel in the bifurcation group in contrast to the non-bifurcation group（81.25% vs.50.21%,P0.01）.In the bifurcation group,68.75% of ruptured plaque was located in the upstream site of bifurcation.Conclusion In IRAs of STEMI patients,the incidence of plaque rupture in vessel bifurcation is relatively low,and bifurcation plaque rupture is often seen in upstream of LAD-diagonal（D） bifurcation.

关 键 词：急性ST段抬高 心肌梗死 梗死相关动脉 分叉病变 血栓性病变 斑块稳定性 冠脉造影 

分 类 号：R543.3[医药卫生—心血管疾病]