非ST段抬高型心肌梗死患者梗死相关血管闭塞状态与血栓类型的关系  

The relationship between the status of infarct-related artery occlusion and thrombus types in patients with non-ST-segment elevation myocardial infarction

作　　者：何晴 董淑娟[1] 李静超[1] 余海佳 宋慧慧[1] 崔路乾 楚英杰[1] HE Qing;DONG Shu-juan;LI Jing-chao;YU Hai-jia;SONG Hui-hui;CUI Lu-qian;CHU Ying-jie(Department of Cardiology,Henan UniversityPeople's Hospital,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心内科,河南郑州450003

出　　处：《中国介入心脏病学杂志》2024年第4期203-210,共8页Chinese Journal of Interventional Cardiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220001)。

摘　　要：目的运用光学相干断层成像(OCT)探讨非ST段抬高型心肌梗死(NSTEMI)患者的梗死相关血管(IRA)闭塞状态与血栓类型的关系。方法回顾性研究2021年10月至2023年8月于河南省人民医院行急诊冠状动脉介入治疗且术中使用OCT检查的NSTEMI患者170例,其中IRA完全闭塞组83例,IRA非完全闭塞组87例,结合患者基线特征、造影结果及OCT结果进行比较分析。结果与IRA非完全闭塞组相比,IRA完全闭塞组的患者更年轻(P=0.013),男性比例更高(P=0.026),而患高血压病(P=0.010)和糖尿病(P=0.033)的比例较低。冠状动脉造影结果表明,IRA完全闭塞组IRA多见于左回旋支,而IRA非完全闭塞组多见于左前降支(P=0.012);IRA完全闭塞组侧支循环分级Ⅱ~Ⅲ级的比例高于IRA非完全闭塞组(P=0.022)。OCT结果显示,IRA完全闭塞组多数情况下由斑块破裂事件引起(P=0.014),主要以红色/混合血栓为主(P<0.001);而IRA非完全闭塞组则更常见于斑块侵蚀事件(P=0.014),以白色血栓为主(P<0.001)。结论NSTEMI患者IRA完全闭塞常发于左回旋支,且患者更年轻,血栓类型以红色/混合血栓为主,而IRA非完全闭塞病变以白色血栓为主。Objective To explore the relationship between the status of infarct related artery(IRA)occlusion and thrombus types in patients with non-ST-segment elevation myocardial infarction(NSTEMI)using optical coherence tomography(OCT).Methods A total of 170 NSTEMI patients who underwent emergency percutaneous coronary intervention at Henan Provincial People's Hospital from October 2021 to August 2023 and underwent OCT examination were included in the study.Among them,83 cases were in the total occlusion group and 87 cases were in the non�total occlusion group.The baseline characteristics,coronary angiography findings,and OCT results of the patients were compared and analyzed.Results Compared with the non-total occlusion group,the patients in the total occlusion group were more younger(P=0.013),the proportion of male was higher(P=0.026),and the proportion of patients with hypertension(P=0.010)and diabetes(P=0.033)was lower.In the total occlusion group,left circumflex artery(LCX)served as the main IRA,whereas in the non-total occlusion group,left anterior descending(LAD)was the predominant IRA(P=0.012);In addition,there was a significantly higher occurrence of rentrop gradeⅡ~Ⅲin the total occlusion group compared to the non-total occlusion group(P=0.022).The OCT results showed that in most cases,the total occlusion group was caused by plaque rupture events(P=0.014),mainly red/mixed thrombus(P<0.001);The non-total occlusion group was more commonly associated with plaque erosion events(P=0.014),with white thrombus being the main cause(P<0.001).Conclusions Total occlusion of infarct-related artery in NSTEMI patients often occurs in the LCX,and the patient is more younger,the thrombus type is mainly red/mixed thrombus,while non-total occlusion lesions are mainly white thrombus.

关 键 词：非ST段抬高型心肌梗死 光学相干断层成像 梗死相关血管 血栓类型 

分 类 号：R541[医药卫生—心血管疾病]