血管内超声在冠状动脉支架术后再狭窄患者预后影响因素分析中的应用  

Application of intravascular ultrasound in analysis on influencing factors of prognosis in patients with different coronary artery in-stent restenosis

作　　者：崔燕[1] 史永锋[1] 郭子源[1] 刘斌[1] 王金鹏[1] 赵雷[1] 王珺楠[1] 朴金花[2] 

机构地区：[1]吉林大学第二医院心内科,吉林长春130041 [2]延边大学附属医院干部病房,吉林延吉133000

出　　处：《吉林大学学报（医学版）》2016年第4期746-752,共7页Journal of Jilin University：Medicine Edition

基　　金：国家自然科学基金资助课题(81570250);吉林省卫计委科研基金资助课题(2012Z070)

摘　　要：目的:收集应用血管内超声技术(IVUS)检测发生冠状动脉支架术后支架内再狭窄(ISR)患者的影像学数据及相关资料,分析ISR的危险因素,提出合理的干预策略。方法:将50例ISR患者随机分为ISR≤50%组(药物组)14例和ISR>50%组36例(根据患者意愿及经济情况分为药物球囊治疗组16例和支架治疗组20例)。应用IVUS虚拟组织学技术,比较各组患者采用不同治疗方法治疗前后斑块面积、病变位置、组织构成和血栓等影响预后的因素,并随访6个月后的数据变化。结果:IVUS检测,与术前比较,行介入干预治疗的ISR患者斑块面积和斑块负荷均明显减少(P<0.05),但药物球囊治疗组患者斑块缩减程度小于支架治疗组(P<0.05),纤维组织成分无明显变化(P>0.05),钙化组织所占比例升高,但差异无统计学意义(P>0.05)。结论:病变狭窄程度高且纤维成分多,斑块成分不均一且分布弥漫伴迂曲钙化的患者ISR发生率均较高。ISR发生与斑块壁厚薄、脂质成分含量、斑块不稳定程度和坏死组织多少无明显关联。Objective：To collect the imaging data and related materials of the patients with in-stent restenosis（ISR）after coronary artery stent operation with intravascular ultrasound（IVUS）,and to analyze the risk factors of ISR,and to propose the reasonable intervention strategies.Methods：Fifty patients with ISR were divided into ISR ≤ 50% drug group（n=14）and ISR 〉50% drug group（n=36）,including drug-coated balloon therapy group（n=16）and stent treatment group（n=20）;IVUS virtual organization technology was used to compare the plaque area,location,tissue composition,thrombus and other factors of the patients in various groups after treatment;the data changes after 6 months of follow-up were analyzed.Results：The IVUS results showed the plaque areas and plaque loads of the ISR patients treated with intervention were significantly reduced compared with before operation（P〈0.05）;the plaque compression degree of the patients in drug-coated balloon therapy group was lower than that in stent treatment group（P〈0.05）,but the differences were not found between drug-coated balloon therapy group and stent treatment group in fibrous tissue components and calcified tissue proportion（P〈0.05）.Conclusion：The ISR rate is higher in the patients with high degree of fiber components,plaque composition heterogeneity and distribution of diffuse tortuous and calcified lesions.ISR has no significant correlation with the plaque wall thickness and lipid content and plaque instability and necrotic tissue proportion.

关 键 词：支架内再狭窄 血管内超声 虚拟组织学 药物球囊 

分 类 号：R541.4[医药卫生—心血管疾病]