药物支架置入后管腔扩大机制的血管内超声研究  

Mechanisms of lumen enlargement after drug-eluting stent:an intravascular ultrasound study

作　　者：吴小凡[1] 郭成军[1] 杨娅[2] 迟云鹏[1] 何东方[1] 赵林[1] 卢春山[1] 张晓江[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]首都医科大学附属北京安贞医院超声诊断科

出　　处：《临床心血管病杂志》2013年第12期901-903,共3页Journal of Clinical Cardiology

基　　金：国家自然科学基金资助项目(No:81000655);教育部新世纪优秀人才资助项目(No:NCET-11-0898);北京市自然科学基金资助项目(No:7122057)

摘　　要：目的：应用血管内超声（IVUS）比较分析不稳定型心绞痛（UA）和稳定型心绞痛（SA）患者药物支架（DES）置入后血管管腔扩大的机制。方法：对58例US和44例SA患者于支架置入前、后行血管内超声检查，分析DES置入前、后血管管腔和外弹力膜以及斑块体积变化。结果：DES置入后2组均伴有斑块减少和血管正性重构，UA组血管管腔扩大41％源于斑块减少，59％源于血管正性重构，而SA组分别为20％和80％。与SA组比较，UA组DES置入后斑块体积减少更明显[（25．9±20．5）mm^3：（10．9±7．7）mm^3，P〈0．001]。多因素回归分析显示，斑块减少是肌酸激酶同工酶（CK—MB）升高的独立预测因子（OR=4．821，95％C1：1．572～19．384，P=0．015）。结论：与SA患者比较，UA患者DES置入后斑块体积明显减少．且伴随CK—MB升高，UA患者DES置入后伴随斑块减少及其继发的远端微栓塞减少。Objective： Application of intravascular ultrasound （IVUS） to compare mechanisms of lumen enlargement after drug-eluting stent （DES） implantation in patient with unstable angina （UA） and stable angina （SA）. Method：All 58 cases of UA patients and 44 cases of SA patients were recieved IVUS before and after stent implantation. The lumen volume, external elastic membrane volume and plaque volume were all measured. Result： Plaque reduction and vessel positive remodeling occurred in both groups after DES implantation. After stenting, 41% of the lumen volume increase in UA group were due to the reduction of mean plaque volume , and 59% were attributable to increase of external elastic membrane volume, while the corresponding figures in SA group was 20% and 80% （P〈0.05）. Plaque volume reduction in overall analysis segment was significantly greater in UA group than that in SA group [（25.9±20.5）mm^3 ： （10.9±7.7）mm^3, P〈0.001]. Plaque volume reduction was the only significant predictor of the MB fraction of creatinine kinase （CK-MB） release in a multiple regression model （OR=4. 821, 95%CI：1. 572-19. 384, P=0. 015）. Conclusion：Serial volumetric IVUS assessment reveals that plaque volume reduction in patients with UA is significantly greater than those in patients with SA, and is associated with postprocedural CK-MB releasing.

关 键 词：冠状动脉疾病 药物支架 血管内超声 

分 类 号：R543.3[医药卫生—心血管疾病]