虚拟组织学-血管内超声分析不稳定心绞痛易损斑块与血脂水平的相关性  

The relationship between blood lipids levels and coronary plaque composition in patients with unstable angina: analysis by a virtual histology intravascular ultrasound

作　　者：张波[1] 张邑[1] 何云[1] 谭虎[1] 于学军[1] 李爱民[1] 晋军[1] 宋耀民[1] 黄岚[1] 

机构地区：[1]第三军医大学第二附属医院心内科,重庆400037

出　　处：《实用医院临床杂志》2015年第6期37-40,共4页Practical Journal of Clinical Medicine

摘　　要：目的应用虚拟组织学-血管内超声(virtual histology intravascular ultrasound,VH-IVUS)分析不稳定型心绞痛(unstable angina,UA)患者冠脉斑块的特点,探讨斑块结构与血脂水平的相关性。方法选取UA患者41例,结合冠脉造影、血管内超声检查发现斑块破裂等,综合确定罪犯病变。对比最小管腔面积(MLA)处斑块各成分面积绝对值及相对值、整个斑块成分体积绝对值及相对值与血脂水平的相关性。结果 MLA处,坏死核心(NC)的面积百分比与血脂各项均无明显相关。NC面积绝对值与TG呈正相关(P<0.01),与HDL-C呈负相关(P<0.05)。在整个斑块节段中,NC体积相对值与TC、LDL-C及LDL/HDL呈正相关(均P<0.05)。但斑块各成分的绝对体积与血脂各项均无相关性。结论 TC、LDL-C及LDL-C/HDL-C与斑块的组成,尤其是斑块NC区的体积百分比相关,有望成为辅助冠心病斑块成分分析的无创性检查。Objective We used virtual histology intravascular ultrasound to evaluate the relationship between blood lipids and plaque composition in patients with unstable angina（ UA）. Methods Forty-one UA patients were included in our study. Culprit lesion were identified by analyzing ST-T alternation on electrocardiograms,left ventricular wall motion abnormalities,angiographic complex lesions and IVUS-detected plaque rupture. We performed VH-IVUS examination on each culprit lesion and analyzed the relationship between blood lipids and VH-IVUS characters of the culprit lesions. Results At the minimal lumen area site,percent of necrotic core area and blood fat had no correlation. The area of necrotic core was positively associated with triglyceride（ P〈0. 01）,and negatively associated with HDL-C（ P〈0. 05）. Necrotic core component was positively associated with triglyceride,LDL-C and LDL/HDL（ P〈0. 05）. No significant correlations were observed between blood fat and the composition of plaque in patients with UA. Conclusion Cholesterol,LDL-C and the ratio of LDL-C/HDL-C are all associated with the component of necrotic core,which can influence the plaque vulnerability. Therefore,blood lipids can be used as predictor of the severity of the coronary artery disease.

关 键 词：虚拟组织学-血管内超声 不稳定性心绞痛 粥样斑块 血脂 

分 类 号：R541.4[医药卫生—心血管疾病] R445.1[医药卫生—内科学]