易损斑块对晚期药物支架贴壁不良影响的虚拟组织学血管内超声研究  

Vulnerable plaque is associated with late stent malapposition after drug-eluting stent implantation: a virtual histology intravascular ultrasound analysis

作　　者：吴小凡[1,2] 郭成军[1,2] 葛长江[1,3] 杨娅[1,4] 方冬平[1,2] 迟云鹏[1,2] 张晓江[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心内六科,100029 [3]北京市心肺血管疾病研究所心内一科,100029 [4]北京市心肺血管疾病研究所超声科,100029

出　　处：《心肺血管病杂志》2014年第6期857-860,865,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：教育部新世纪优秀人才资助项目(NCET-11-0898);国家自然科学基金资助项目(81000655);北京市自然科学基金资助项目(7122057);北京市卫生系统高层次卫生技术人才培养计划(2013-3-010)

摘　　要：目的：探讨基线斑块组织分型对药物支架（drug-eluting stent,DES）置入术后晚期支架贴壁不良（late stent malapposition,LSM）的影响.方法：入选不稳定性心绞痛患者112例,行冠状动脉原位病变药物支架置入及基线和随访,平均随访时间（11.5±1.7）个月,虚拟组织学血管内超声（VH-IVUS）检查,分为易损斑块组（n=38）和非易损斑块组（n=74）.结果：16例患者（14.3％）随访时发现LSM,易损斑块组明显多于非易损斑块组（28.9％ vs.6.8％,P=0.001）.易损斑块组糖尿病（52.6％ vs.28.4％,P=0.012）,支架长度,坏死核心体积[（28.7±9.6）vs.（22.0±11.2）mm3,P =0.004]及其百分比[（25.7±6.6）vs.（21.5±6.6）％,P＜0.001]均明显高于非易损斑块组.多因素回归分析显示,易损斑块（OR=3.162,95％CI：1,052 ～ 11.278,P=0.001）和糖尿病（OR=1.145,95％ CI：1.005～1.332,P=0.024）是LSM的独立预测因素.结论：易损斑块和糖尿病与不稳定心绞痛DES置入术后LSM形成有关.Objective：The present study aimed to investigate the impact of plaque composition on late stent malapposition （LSM） after drug-eluting （DES） implantation. Methods： We evaluated the relation between plaque components at baseline and LSM after DES implantation in 112 patients in whom virtual histology intravascular ultrasound （VH-IVUS） was performed at index （before intervention） and follow up mean （ 11.5 ± 1.7 ） months. All patients were divided into 2 groups ： patients with vulnerable plaque and patients without vulnerable plaque based on baseline VH-1VUS. Results： LSM occurred in 16 patients （ 14. 3% ） and vulnerable plaque was associated with higher incidence of LSM （28.9% vs. 6.8% ,P = 0. 001 ）. Patients with vulnerable plaque were presented with more diabetics （ 52. 6% vs. 28.4% , P = 0. 012） compared with those without LSM. The stent length in patients with vulnerable plaque was longer than in patients without vulnerable plaque. Patients with vulnerable plaque had more pre-stenting necrotic core volume [ （ 28.7 ± 9.6） vs. （ 22. 0 ±11.2）mm^3, P=0.004] and percentage [（25.7±6.6） vs. （21.5±6.6）%, P〈0.001] compared with those without vulnerable plaque. Independent predictors of LSM were vulnerable plaque（ OR = 3. 162,95% CI： 1. 052 - 11. 278, P = 0. 001 ） and diabetes mellitus （ OR = 1. 145,95% CI： 1. 005 - 1. 332, P = 0. 024）.Conclusion： vulnerable plaque especially in unstable angina patients with diabetes mellitus is associated with the development of LSM after DES implantation.

关 键 词：易损斑块 晚期支架贴壁不良 虚拟组织学血管内超声 药物洗脱支架 

分 类 号：R54[医药卫生—心血管疾病]