血管内超声观察急性冠脉综合征非显著狭窄的病变斑块破裂及形态特点  

Morphologic features of coronary plaque rupture in acute coronary syndromes without significant angiographic lesion detected by intravascular ultrasound

作　　者：周华[1,2] 王娟[1,2] 何晓燕[1,2] 庄少伟[1,2] 来晏[1,2] 姚义安[1,2] 刘学波[1,2] 汪程 

机构地区：[1]上海市东方医院 [2]同济大学附属东方医院心内科,200120 [3]新疆维吾尔自治区莎车县人民医院心内科,844700

出　　处：《重庆医学》2013年第17期1943-1945,1948,共4页Chongqing medicine

基　　金：上海市浦东新区社发局卫生科技基金资助项目(PW2006A-2)

摘　　要：目的是用血管内超声(IVUS)观察没有显著冠脉狭窄病变的急性冠脉综合征(ACS)患者缺血相关病变斑块的特点。方法 45例经血管造影无显著冠脉狭窄[狭窄(31±15)%]的急性冠脉综合征患者(ACS)行冠脉内IVUS检查。患者分为斑块破裂组(16例)和无斑块破裂组(29例)。定性分析确定斑块的类型,定量分析斑块加中膜面积、斑块容积、斑块负荷、血管重构指数。结果所有破裂的均为软斑块或混合斑块。斑块破裂组斑块破裂与更大的斑块负荷[(48.6±8.7)%vs(38.5±11.8)%,(P<0.000 5)]、更显著的斑块+中膜面积[(7.2±2.6)mm2 vs(5.1±2.4)mm2,(P<0.001)]、更大的斑块容积[(154.6±101.4)mm3 vs(96.2±82.1)mm3,(P<0.03)]、斑块容积与斑块长度比更高[(8.0±4.1)mm3/mm vs(5.9±3.7)mm3/mm,(P<0.003)]相关,同时,正性重构要多于负性重构(P<0.005)。无斑块破裂组中不同类型的动脉血管重构无明显差异。结论急性冠脉综合征的病变斑块破裂常发生在斑块负荷较重及有动脉正性重构的大容量斑块。Objective This study was designed to report the characteristics of the culprit lesion with plaque without significant angiographic stenosis after acute coronary syndromes（ACS）by intravascular ultrasound（IVUS）.Methods After ACS,IVUS was performed in 45patients（44.3years±11.3）without significant angiographic stenosis（31±15%）.Patient were divided into two groups：Group with plaque rupture（16patients）and Group without plaque rupture（29patients）.Qualitative analysis defined the type of plaque,and quantitative analysis evaluated plaque plus media area,plaque volume,plaque burden,and arterial remodeling index.Results All patients with rupture showed soft or mixed plaque,In group with plaquerupture,plaque rupture was associated with a larger plaque burden[（48.6±8.7）%vs（38.5±11.8）%,P0.000 5],a more significant plaque plus media area[（7.2±2.6）mm2 vs（5.1±2.4）mm2,P0.001],agreater plaque volume[（154.6±101.4）mm3 vs（96.2±82.1）mm3,P0.03],and a higher ratio of plaque volume over length[（8.0±4.1）mm3/mm vs（5.9±3.7）mm3/mm,P0.003].In group with plaquerupture,positive remodeling was more frequent than negative remodeling（P0.005）.In group with plaquerupture,there was no significant difference between the two types of remodeling.Conclusion The plaque ruptures responsible for ACS frequently appear on voluminous plaques with a large plaque burden and positive arterial remodeling.

关 键 词：急性冠状动脉综合征 血管内超声 动脉重构 斑块破裂 

分 类 号：R541.4[医药卫生—心血管疾病]