急性冠状动脉综合征和稳定性心绞痛患者非罪犯病变组织学特征比较:彩色编码血管内超声(iMAP-IVUS)研究  

Comparison of histological characteristics between acute coronary syndrome and stable angina pectoris:color-coded intravascular ultrasound analysis of non-culprit lesions

作　　者：陈进 单守杰[2] 刘志忠[2] 张俊杰[2] 金国珍[2] Chen Jin;Shan Shoujie;Liu Zhizhong;Zhang Junjie;Jin Guozhen(Department of Cardiology,Zhangjiagang Hospital of Traditional Chinese Medicine,Suzhou 215600,China;Department of Cardiology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]张家港市中医医院心内科,215600 [2]南京医科大学附属南京医院心内科,210006

出　　处：《中国心血管杂志》2020年第6期525-529,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的应用彩色编码血管内超声(iMAP-IVUS)比较急性冠状动脉综合征(ACS)和稳定性心绞痛(SAP)患者的非罪犯病变斑块组织学特征。方法连续选取152例行经皮冠状动脉介入治疗的冠心病患者,根据入院时诊断将患者分为ACS组(62例)和SAP组(90例),对非罪犯病变行iMAP-IVUS检查,比较两组之间斑块的组织学特征。采用多因素logistic回归分析ACS的危险因素。结果两组之间斑块体积相似(P>0.05),ACS组的纤维体积百分比(70.3%±9.8%)显著低于SAP组(77.1%±7.4%,P<0.01),但ACS组的脂质体积百分比(8.3%±2.5%比6.1%±2.4%)和坏死体积百分比(15.3%±7.6%比9.8%±4.6%)显著高于SAP组(均为P<0.01)。两组纤维体积百分比与斑块总体积均负相关(均为P<0.01),坏死体积百分比与斑块总体积均正相关(均为P<0.01)。和SAP组(r=0.46)相比,ACS患者(r=0.60)斑块体积和坏死体积百分比的相关性更强(P<0.05)。多因素logistic回归分析显示坏死体积百分比是发生ACS的独立危险因素(OR=8.73,95%CI:2.21~26.40,P<0.001)。结论较SAP患者,ACS患者的非罪犯病变更具易损性,坏死体积百分比是发生ACS的独立危险因素。Objective To investigate the histological characteristics of non-culprit lesions by using color-coded intravascular ultrasound(iMAP-IVUS)in patients with acute coronary syndrome(ACS)or stable angina pectoris(SAP).Methods A total of 152 patients with coronary heart disease who underwent percutaneous coronary intervention were divided into ACS group(n=62)or SAP group(n=90)according to clinical features at admission.Non-culprit lesions were imaged by 40-MHz iMAP-IVUS,and the plaque characteristics were compared between groups.Multivaricte logisitc regression analyses was used to avaluate the risk factor for ACS.Results Plaque volume was similar between the two groups(P>0.05).The fibrotic volume(%FV)was less in the ACS group(70.3%±9.8%)than that in the SAP group(77.1%±7.4%,P<0.01),whereas the lipidic volume(%LV)(8.3%±2.5%vs.6.1%±2.4%,P<0.01)and necrotic volume(%NV)(15.3%±7.6%vs.9.8%±4.6%,P<0.01)were greater in the ACS group.An negative correlation was found between%FV and total plaque volume,and a positive correlation was found between%NV and total plaque volume(all P<0.01).Furthermore,the slope of the regression line showing the relation between plaque volume and necrotic volume was significantly steeper for the ACS group than for the SAP group(P<0.05).Furthermore,the stronger correlation between plaque volume and%NV was observed in ACS patients(r=0.60)than in SAP patients(r=0.46)(P<0.05).Multivariate logistic regression analyses demonstrated that%NV was a significant determinant of ACS(OR=8.73,95%CI:2.21-26.40,P<0.001).Conclusions The present study shows non-culprit lesions are more vulnerable in ACS patients than in SAP patients and the percentage of necrotic volume is an independent risk factor for ACS.

关 键 词：急性冠状动脉综合征 斑块 彩色编码血管内超声 

分 类 号：R541.4[医药卫生—心血管疾病]