血管内超声与光学相干断层扫描在冠状动脉临界病变中的长期随访对比研究  

The ability of optical coherence tomography for assessment of intermediate coronary stenosis comparison with intravascular ultrasound in long-term follow-up STUDY

作　　者：方哲[1,2] 周玉杰[1,2] 刘宇扬[1,2] 史冬梅[1,2] 赵迎新[1,2] 李艳芳[1,2] 杨士伟[1,2] 王志坚[1,2] 胡宾[1,2] 贾得安[1,2] 聂斌[1,2] 葛海龙[1,2] 王健龙[1,2] 周志明[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所十二病房,北京100029

出　　处：《心肺血管病杂志》2013年第3期255-258,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:研究血管内超声(intravenous ultrasound,IVUS)与光学相干断层扫描(optical coher-ence tomography,OCT)在冠状动脉临界病变中的长期随访研究。方法:共入选经过冠状动脉造影(至少4体位造影)证实病变狭窄处于临界病变的患者90例。将入选者按照2∶1随机分为:血管内超声组(IVUS)60例,光学相干断层成像(OCT)组30例。通过血管内超声定量分析最小管腔直径、参考血管直径、最小管腔面积等参数指标;通过光学相干断层扫描分析最小管腔直径、最小管腔面积。同时依据两组检查方法不同特征确定斑块的性质进行定性亚组分析:纤维性斑块、钙化斑块及脂质斑块等,对于高危易损斑块进行冠状动脉介入治疗,术后规律服用药物,观察两组术后住院期间、30d、3个月、9个月、1年和2年的主要心血管事件。采用COX回归模型分析两组2年内免于心血管事件的差异。结果:IVUS和OCT进行亚组软斑块分析,两组测得最小管腔直径分别为[(1.84±0.06)vs.(1.84±0.13)mm,P=0.947]。另外,在最小管腔面积方面两组分别为[(4.7±0.98)vs.(4.8±1.17)mm2,P=0.853]。OCT组通过分析软斑块纤维帽厚度为(94±24.72)μm。通过COX回归模型显示,两组在免于心血管事件的差异无统计学意义(P=0.826)。结论:对于临界病变的患者,采用IVUS或OCT成像系统能够更好的分辨血管内斑块性质,尤其易识别易损斑块。对于临界病变的患者,采用介入影像学方法进行测量分析是安全的、可靠的,能更好指导临床治疗。Objective：This study aims to compare the prognosis of patients with intermediate coronary stenosis by quantitative optical coherence tomography（OCT） and intravascular ultrasound（IVUS） in long-term follow-up.Methods：A total of 90 coronary intermediate stenosis patients after coronary angiogary（at least 4 position imaging confirmed diameter stenosis rate between 30%～50%） were enrolled.The patients were randomly divided into 2 groups： intravascular ultrasound（IVUS） group 60 cases,optical coherence tomography（OCT） group 30 cases.By IVUS or OCT analysis minimum lumen diameter,reference vessel diameter,diameter stenosis rate,minimum lumen area et al.In some high risk vulnerable plaques patients were given coronary intervention treatment,and observed two groups of postoperative hospital stay,30 days,3 months,9 months and 1 year,2 years of major cardiovascular events.Results：IVUS and OCT for soft plaque subgroup analysis,measured minimum lumen diameter were（1.84±0.06）mm vs.（1.84±0.13）mm,P=0.947,respectively.In addition,in minimum lumen area of two groups were（（4.7±0.98）vs.（4.8±1.17）mm2,P=0.853）,OCT could estimate the fibrous cap thickness,and it was（94±24.7）μm.Through the COX regression model showed that the two groups has down trend closely,P=0.826,did not show the obvious statistical significance.Conclusion：In intermediate lesions patients,IVUS or OCT suggested that it maybe well suited for identifying vulnerable plaques in patients at high risk,IVUS and OCT could both avoid higher risk of MACE.

关 键 词：易损斑块 冠状动脉疾病 血管内超声 光学相干断层扫描 

分 类 号：R54[医药卫生—心血管疾病]