血管内超声评估冠状动脉管腔狭窄伴外弹力膜扩张性血管重构的临床研究  

Intravascular Ultrasound Evaluation on Coronary Artery Remodeling for Lumen Stenosis With Enlarged External Elastic Membrane in Patients of Acute Coronary Syndrome

作　　者：宋达琳[1] 祝庆[1] 刘国树[2] 康维强[1] 

机构地区：[1]青岛市市立医院青岛市老年医学研究所老年内科,山东省266071 [2]中国人民解放军总医院老年心血管内科

出　　处：《中国循环杂志》2011年第6期414-417,共4页Chinese Circulation Journal

基　　金：青岛市科技局重点项目资助(07-2-1-9-nsh)

摘　　要：目的:应用血管内超声评估冠状动脉(冠脉)管腔狭窄伴外弹力膜扩张性血管重构的临床研究。方法:103例急性冠状动脉综合症(ACS)患者,男68例,女35例,年龄平均(60±11)岁;常规冠脉造影,血管内超声检测103处靶病变和参考血管处动脉粥样斑块形态学参数。将重构指数>1为正重构组(n=67),重构指数≤1为负重构组(n=36);计算靶病变处管腔面积与平均参考段的管腔面积的比值(称为管腔狭窄比值)。比较分析重构分组之间的斑块形态学特点,比较两组在病变处与参考段之间的差异;并进行管腔狭窄、外弹力膜扩张与斑块负荷的相关性分析。结果:103例患者中有5例ACS患者靶病变的管腔面积与平均参考血管的管腔面积相同,1例患者未见参考血管段的病变。102例存在参考血管段病变患者的资料统计显示,靶病变处与近端和远端参考段比较,斑块负荷的明显增加[依次为(71.76±9.17)%,(39.76±12.54)%,(32.38±13.97)%];管腔面积缩小[依次为(3.81±1.09)mm^2,(8.91±2.43)mm^2,(9.03±2.16)mm^2];靶病变处与远端参考段比较,病变处外弹力膜(EEM)面积缩小[(14.71±2.89)mm^2 vs(28.37±4.48)mm^2],差异有统计学意义(P均<0.001)。管腔狭窄比值与斑块负荷呈负相关性(r=-0.84,P<0.001)而与管腔面积呈正相关性(r=0.70,P=0.007);重构指数与其他参数未见相关性。结论:ACS患者冠状动脉存在着管腔狭窄伴外弹力膜扩张的双向重构,管腔狭窄比值可能是评估重构的重要指标。Objective：To investigate the characteristics of coronary remodeling for lumen stenosis accompanied with enlarged external elastic membrane（EEM） in patients of acute coronary syndrome（ACS）. Methods ：We studied 103 ACS patients who received elective coronary artery angiography and IVUS, 103 target lesions were compared with the reference vessel sites. According to remodeling index （RI） , the patients were divided as positive remodeling ： R≥ 1, n = 67 and negative remodeling： RI ≤1, n = 36. The ratio of lumen stenosis was defined as the target lumen area/the average reference lumen cross section area. The plaque parameters,lumen stenosis and EEM conditions were analyzed between two groups of patients. Results：There were 5 patients with the same lumen area to reference vessels, 1 patient without the lesion at the reference vessel site. 102 patients with lesions at reference vessels presented that there were more plaque at target lesion than the near site and remote site of reference vessel as（71.76 ±9. 17 ） %, （ 39. 76 ± 12. 54 ） % and（ 32. 38 ± 13.97 ） %, more diminished lumen area at target lesion as （3.81 ± 1.09 ）mm2, （8.91±2.43 ）mm2 and （9. 03 ±2.16）mm2 ; the target lesion had decreased EEM than remote site of reference vessel as （ 14. 71±2. 89）mm2 vs. （28.37 ±4.48 ）mm2, P〈0. 001 respectively. The ratio of lumen stenosis was negatively related to plaque burden, r = -0. 84, P〈0. 001 and positively related to lumcn area, r = 0. 70, P = 0. 007. Therewere no statistical relationship between RI and other parameters. Conclusion：ACS patients have coronary artery bi-direction remodeling as lumen stenosis accompanied with enlarged EEM The ratio of lumen stenosis might be an important factor for evaluating coronary artery remodeling.

关 键 词：急性冠状动脉综合征 双向重构 管腔 血管内超声 

分 类 号：R541[医药卫生—心血管疾病]