不同类型非钙化冠状动脉斑块对支架成形阻力的比较  

Comparison of the Dilation Resistance to Stenting Between Different Types of Non-calcified Coronary Plaques

作　　者：周逸[1] 陈曼华[1] 熊才金[1] 杨锴[1] 陈刚[1] 杨飞燕[1] 

机构地区：[1]武汉市中心医院心内科,湖北省武汉市430014

出　　处：《中国动脉硬化杂志》2013年第11期1033-1037,共5页Chinese Journal of Arteriosclerosis

基　　金：武汉市卫生局临床医学科研项目(WX11C13)

摘　　要：目的回顾性分析冠状动脉支架术前已行64层螺旋CT冠状动脉成像的病例,比较不同类型非钙化冠状动脉斑块在支架术中对扩张的阻力。方法选择2007年至2012年冠状动脉支架术前已行冠状动脉64层螺旋CT检查的患者116例。依据冠状动脉血管重构系数将非钙化冠状动脉斑块分为正性重构组和非正性重构组。比较两组的临床特征、靶斑块内是否检测出脂质核心、预扩张球囊规格、预扩张球囊充盈压力、支架规格、支架释放压力。结果正性重构组的高敏C反应蛋白水平较高。和非正性重构组比较,脂质核心在正性重构组中检出更多。症状典型的病例中,不稳定型心绞痛在正性重构组多见,稳定型心绞痛在非正性重构组多见。两组预扩张的应用比例相似,两组预扩张球囊规格和预扩张压力无差异。两组支架的规格无差异。正性重构组支架释放压力为1121.64±213.68 kPa,低于非正性重构组的1 232.56±201.95 kPa(P<0.01)。结论和非正性重构组相比,正性重构组斑块内脂质核心更常见,支架植入时对支架成形阻力较小。术前识别冠状动脉重构类型对能否选择支架直接植入有一定指导意义。Aim To compare the dilation resistance during stents implantation between different types of non- clacified coronary plaques by retrospectively investigating patients who received 64-slice spiral computed tomography angiog- raphy before coronary stents implantation. Methods 116 patients who received 64-slice spiral computed tomography angiography before coronary stents implantation from 2007 to 2012 were selected. Non-calcified coronary plaques were di- vided into positive remodeling group and non-positive remodeling group based on remodeling index. Clinical features, lip- id cores, pre-dilatation balloon size and flling pressure, and stent size and pressure were compared. Results High- sensitivity C-reactive protein （hs-CRP） levels were higher in positive remodeling group. The lipid cores were more com- monly observed in positive remodeling group. In patients who have typical symptom, unstable angina was more common in positive remodeling group, and stable angina was more common in non-positive remodeling group. The proportion of ad- ministration of pre-dilatation was similar in two groups. The size and filling pressure of pre-dilation ballons were similar in two groups. The size of stents was similar in two groups. Stent release pressure in positive remodeling group was signifi- cantly lower than that observed in non-positive remodeling group （ 1 121.64 ~ 213.68 kPa vs 1 232. 56 ~ 201.95 kPa, P 〈 O. O1 ）. Conclusions Compared with non-positive remodeling group, the lipid cores were more common in positive re- modeling group, therefore the dilation resistance was lower in positive remodeling group during stents expansion. Preoper- ative identification of lesion remodeling index was helpful for choosing direct stent implantation rightly.

关 键 词：冠状动脉 正性重构 脂质 支架 体层摄影术 螺旋计算机 

分 类 号：R5[医药卫生—内科学]