不同类型急性冠状动脉综合征患者罪犯病变的形态学特点  

Morphological characteristics of culprit lesions in patients with different types of acute coronary syndrome

作　　者：杨亚攀 董淑娟 李静超 余海佳 宋慧慧 楚英杰 YANG Yapan;DONG Shujuan;LI Jingchao;YU Haijia;SONG Huihui;CHU Yingjie(Heart Center of Henan Provincial People s Hospital&Central China Fuwai Hospital,Zhengzhou,Henan 450000,China;Department of Cardiology,Henan Provincial People’s Hospital&People s Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China;Department of Emergency,Henan Provincial People’s Hospital&People s Hospital of Zhengzhou University,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省人民医院心脏中心华中阜外医院,河南省郑州市450000 [2]河南省人民医院郑州大学人民医院心血管内科,河南省郑州市450000 [3]河南省人民医院郑州大学人民医院急诊科,河南省郑州市450000

出　　处：《中国动脉硬化杂志》2021年第4期322-326,共5页Chinese Journal of Arteriosclerosis

基　　金：河南省科技攻关计划项目(122102310068)。

摘　　要：目的比较急性ST段抬高型心肌梗死(STEMI)和非ST段抬高型急性冠状动脉综合征(NSTEACS)患者罪犯病变的形态学特点。方法入选2018年1月至2019年12月在河南省人民医院接受冠状动脉造影的急性冠状动脉综合征患者93例,对其临床资料进行回顾性分析。根据诊断类型,将患者分为STEMI组(45例)和NSTEACS组(48例)。术中在介入治疗前使用光学相干断层成像观察罪犯病变的破裂斑块、斑块脂质成分、纤维帽厚度、血栓类型及管腔面积。结果STEMI组破裂斑块(68.9%比39.6%,P=0.005)、富含脂质斑块(88.9%比68.8%,P=0.018)、薄纤维帽粥样斑块(71.1%比37.5%,P=0.001)以及红色血栓(73.3%比29.2%,P=0.006)的比例显著高于NSTEACS组。STEMI组斑块破口的最大横截面积显著高于NSTEACS组[(2.45±0.65)mm 2比(1.62±1.01)mm 2,P=0.002]。结论OCT显示STEMI和NSTEACS罪犯病变形态各不同,提示冠状动脉内破裂斑块形态和血栓类型与急性冠状动脉综合征临床表现相关。Aim To compare the morphological characteristics of culprit lesions in patients with acute ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation acute coronary syndrome(NSTEACS).Methods Clinical data of 93 patients accepting coronary angiography and diagnosed with acute coronary syndrome admitted to Henan Provincial People s Hospital from January 2018 to December 2019 were retrospectively analyzed.According to the type of diagnosis,the patients were divided into STEMI group(45 cases)and NSTEACS group(48 cases).During the operation,optical coherence tomography was used to observe the rupture plaque,plaque lipid composition,fiber cap thickness,thrombus type and lumen area of culprit lesions before interventional therapy.Results The proportions of ruptured plaque(68.9%vs 39.6%,P=0.005),lipid-rich plaque(88.9%vs 68.8%,P=0.018),thin-cap fibroatheroma plaque(71.1%vs 37.5%,P=0.001)and red thrombus(73.3%vs 29.2%,P=0.006)in STEMI group were significantly higher than those in NSTEACS group.The maximum cross sectional area of plaque break in STEMI group was significantly higher than that in NSTEACS group[(2.45±0.65)mm 2 vs(1.62±1.01)mm 2,P=0.002].Conclusion OCT show that the morphology of culprit lesions in STEMI and NSTEACS are different,suggesting that the morphology of ruptured plaque and the type of thrombus in coronary artery are related to the clinical manifestations of acute coronary syndrome.

关 键 词：ST段抬高型心肌梗死 非ST段抬高型急性冠状动脉综合征 罪犯病变 光学相干断层成像 

分 类 号：R54[医药卫生—心血管疾病]