经皮冠状动脉腔内成形术后夹层与早期狭窄加重的关系  

Major dissection after PTCA is a strong independent predictor of early luminal deterioration

作　　者：盖鲁粤[1] 王洁[1] 黄大显[1] AD Abhyankar BP Bailey LB ernstein PJ Harris 

机构地区：[1]中国人民解放军总医院心内科,北京100853 [2]澳大利亚悉尼阿尔弗雷德王子医院心内科

出　　处：《中华医学杂志》2000年第7期509-512,共4页National Medical Journal of China

摘　　要：目的　探索夹层与经皮冠状动脉腔内成形 (PTCA)术后早期狭窄加重的关系。方法　从PTCA患者中选出有术后 2 4h内行冠状动脉造影复查的患者 10 5例 ,测量术后即刻和复查时的最小动脉内径 (MLD) ,然后将夹层的分型与MLD进行比较。结果　手术结束时与复查时MLD比较如下 :无夹层术后即刻为 2 .2 3mm± 0 .5 7mm ,复查时为 1.71mm± 0 .78mm(P <0 .0 0 0 1) ;A型分别为2 76mm± 0 .39mm、2 .47mm± 0 .34mm ;B型分别为 2 .18mm± 0 .5 6mm、1.6 5mm± 0 .89mm(P <0 0 0 1) ;C型分别为 2 .19mm± 0 .2 8mm、1.5 2± 0 .6 0mm (P <0 .0 0 1) ;D型分别为 2 .2 8mm± 0 .5 9mm、1.31mm± 0 .82mm(P <0 .0 1) ;E型分别为 2 .2 7mm± 0 .47mm、1.15mm± 0 .86mm(P <0 .0 0 1)。可见MLD的恶化随着夹层的分型而加重 ,A型夹层的变化最小 ,B型夹层的改变次之 ,C、D、E型夹层变化明显 ,其中E型夹层的变化最明显。协方差分析表明 ,PTCA后即刻的MLD与 12h后造影复查时的MLD有显著直线相关 ,夹层的分型也与 12h后的MLD有显著直线相关 ,多元逐步回归表明 ,血管病变支数和夹层类型为影响MLD的独立的因素。结论　即使PTCA后即刻结果尚好 ,术后 12h内MLD也有不同程度的恶化。恶化与残余MLD ,弹性回缩 ,冠状动脉夹层 ,多支血管?Objective To investigate the early natural course of dissection after PTCA and its relation to early luminal deterioration. Methods One hundred and five patients who underwent relook coronary arteriography within 24 hours of PTCA were retrospectively analyzed. The patients were subdivided into no dissection and type A, B, C, D, and E dissection. Minimal luminal diameter (MLD) was measured immediately after PTCA and at relook coronary arteriography. The changes were correlated with the severity of the dissections. Results Immediately after PTCA, the MLD in all 6 groups was >2.0 mm. Except for type A dissection, the MLD, however, was deteriorated significantly at the relook coronary arteriography next day. The factors contributing to the deterioration were analyzed by covariance analysis, which showed a significant linear relation with the MLD immediately after PTCA and the type of dissection. Multivariate stepwise regression analysis was used to investigate if the patients′ demographic factors and coronary lesion characteristics were also related to the MLD deterioration. The results showed that multivessel disease and the type of dissection were two independent risk factors of the MLD deterioration. Conclusion Even if the results immediately after PTCA were acceptable, MLD will deteriorate over time. The degree of the deterioration was not only related to elastic recoil, but also to the type of dissection. Type C, D and E dissections were unstable, causing much more damage to the MLD than type A and B dissections, which mandated immediate stent implantation to prevent early luminal deterioration and late restenosis. Stent implantation was usually unnecessary in type A and B dissections. Multivessel disease was also involved in the process of the MLD deterioration. The mechanism is unclear, but might be related to coronary lesion characteristics.

关 键 词：血管成形术 动脉瘤 再狭窄 冠状动脉夹层 

分 类 号：R541[医药卫生—心血管疾病]