非ST段-抬高急性冠脉综合征与稳定型心绞痛的血管内超声斑块虚拟成像特点比较  

Comparison of plaque characteristics between non-ST-segment elevation acute coronary syndrome and stable angina by virtual histology intravascular ultrasound

作　　者：杨辉剑[1] 钟志安[1] 魏水生[1] 杨峻青[1] 倪忠涵[1] 罗德谋[1] 陈竹君[1] 

机构地区：[1]广东省心血管病研究所,广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2014年第4期501-504,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的比较非ST段-抬高急性冠脉综合征(non-ST-segment elevation acute coronary syndrome,NSTE-ACS)与稳定型心绞痛(stable angina,SA)患者冠状动脉病变斑块的血管内超声虚拟组织成像(virtual histology intravascular ultrasound,VH-IVUS)特点。方法入选81例确诊冠状动脉粥样硬化性心脏病(冠心病)患者行冠状动脉造影及VH-IVUS检查,根据临床表现、心电图及心肌坏死标志物水平分为NSTE-ACS组(47例,70处病变)和SA组(34例,46处病变)。对所有病变进行IVUS影像定量分析,测量指标包括最小管腔直径、最小管腔面积、坏死核心、纤维脂质成分、纤维成分、钙化部分、外弹力膜、斑块负荷及薄纤维帽粥样斑块发生率。结果 NSTE-ACS组斑块病变成分中坏死核心[(1.98±1.07)mm2vs.(1.18±0.81)mm2,t=4.312,P=0.000]、斑块负荷(73.35%±7.73%vs.68.00%±10.28%,t=3.193,P=0.002)及薄纤维帽粥样斑块发生率[45.7%(32/70)vs.19.6%(9/46),χ2=8.306,P=0.005]与SA组比较显著增加,差异有统计学意义,其余指标比较差异无统计学意义(P>0.05)。结论 NSTEACS患者斑块成分与SA患者差异明显,坏死核心、斑块负荷明显增加,薄纤维帽粥样斑块发生率明显升高。Objectives To investigate the plaque characteristics in patients with non-ST-segment elevation acute coronary syndrome （NSTE-ACS） and stable angina （SA） by virtual histology intravascular ultrasound （VH-IVUS）.Methods Totally 81 patients were divided into NSTE-ACS group （n=47,12 with acute myocardial infarction and 35 with unstable angina） and SA group （n=34） by chnical manifestation,electrocardiogram.Markers for myocardial infarction were measured by coronary arterial angiography （CAG） and intravascular unltrasound.An quantitative estimation with intravascular unl^sound of all 70 lesions in NSTE-ACS group and all 46 lesions in SA group included minimal luminal diameter,minimal luminal area,necrotic core,fibrofatty,fibre,dense calcium,extemal elastic membrane,plaque burden and rate of thin-cap fibroatheroma.Results Necrotic core [（1.98±1.07） mm2vs.（1.18±0.81） mm2,t=4.312,P=0.000],plaque burden （73.35%±7.73% vs.68.00%±10.28%,t=3.193,P=0.002） and rate of thin-cap fibroatheroma [45.7% （32/70） vs.19.6% （9/46）,x2=8.306,P=0.005] in NSTE-ACS group were significantly increased than those in SA group（P〈0.05）.Conclusions Necrotic core,plaque burden and rate of thin-cap fibroatheroma significantly increase in patients with NSTE-ACS than in patients with SA.

关 键 词：冠状动脉疾病 急性冠脉综合征 稳定型心绞痛 血管内超声 坏死核心 斑块负荷 

分 类 号：R541.4[医药卫生—心血管疾病]