稳定型冠心病合并H型高血压患者血管内超声虚拟组织学冠脉斑块特征分析  

Study of coronary plaque features in patients with stable coronary heart disease and H-type hypertention by intravascular ultrasound

作　　者：朱桂平[1] 郑坚奕[1] 王宗涛[1] 李搏维 林忠伟[1] 曾智桓[1] 张卫[1] 雷达[1] ZHU Guiping;ZHENG Jianyi;WANG Zongtao;LI Bowei;LIN ZHongwei;ZENG ZHihuan;ZHANG Wei;LEI Da(Department of Cardiology,the First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China)

机构地区：[1]广东药科大学附属第一医院心内科,广东广州510080

出　　处：《广东药科大学学报》2019年第2期296-300,共5页Journal of Guangdong Pharmaceutical University

基　　金：广东省科技计划项目(20130319C)

摘　　要：目的:研究稳定型冠心病合并H型高血压患者血管内超声虚拟组织学冠脉斑块特征。方法 52例稳定型冠心病且合并高血压患者,依据血浆同型半胱氨酸(Hcy)水平分为合并H型高血压组、合并非H型高血压组。所有患者行冠脉造影检查确诊,计算3支血管病变比例及Gensini评分;对冠脉靶病变进行血管内超声检查及虚拟组织学分析,研究两组血管重构及斑块病变特征。结果与合并非H型高血压组比较,合并H型高血压组冠脉3支血管病变比例增高(57.14%vs 41.67%)、Gensini评分增高(30.82±7.18 vs 26.35±4.27),差异有统计学意义(P<0.05);合并H型高血压组血管重构指数、正性重构比例、斑块脂质坏死组织面积、纤维脂质组织面积较合并非H型高血压组升高(P<0.05),斑块钙化组织面积、纤维组织面积两组比较差异无统计学意义(P>0.05)。相关分析显示血浆Hcy水平与3支血管病变比例、Gensini评分、血管重构指数、正性重构比例、脂质坏死组织面积、纤维脂质组织面积存在正相关关系。结论稳定型冠心病合并H型高血压患者,其高血浆Hcy水平不但影响冠脉病变的范围和严重程度,还可能进一步加重血管重塑及斑块组分的差异,造成斑块不稳定趋势。Objective To study the coronary plaque features in patients with stable coronary heart disease and H-type hypertention by intravascular ultrasound (IVUS).Methods Fifty-two patients with stable coronary heart disease combined hypertension were divided into two groups based on plasma homocysteine (Hcy) level,including H-hypertension group and the non-H-type hypertension group.The clinical data of gender,age,body mass index,blood pressure and blood lipids were compared between the two groups.All patients underwent coronary angiography to calculate the proportion of three-vessel disease and Gensini score.The coronary plaque features were evaluated by IVUS and virtual histology.Results Compared with non-H-type hypertension group,there were more three-vessel diseases (57.14% vs 41.67%) and Gensini score (30.82±7.18 vs 26.35±4.27) in H-type hypertension group ( P< 0.05).Meantime,the vascular remodeling index,positive remodeling ratio,plaque lipid necrotic and fibrotic lipid tissue area,but not plaque calcification tissue area and fibrous tissue area,were significantly increased in the H-type hypertension group.There was a positive correlation between plasma Hcy and these indexes including three-vessel disease ratio,Gensini score,vascular remodeling index,positive remodeling ratio,lipid necrotic tissue area and fibrotic lipid tissue area by correlation analysis.Conclusion High-level of plasma Hcy in patients with stable coronary heart disease and H-type hypertension not only affect the extent and severity of coronary artery disease,but also may aggravate the differences in vascular remodeling and plaque components,resulting in plaque instability.

关 键 词：高血压 冠心病 同型半胱氨酸 血管内超声 虚拟组织学 

分 类 号：R541.4[医药卫生—心血管疾病]