急性心肌梗死患者冠状动脉胆固醇结晶与非罪犯病变中斑块特征的关系:一项OCT研究  

The association of cholesterol crystals and non-culprit plaque characteristics in AMI patients:an OCT study

作　　者：赵嘉伟 赵锐 房超 陈昱竹 徐学明 崔丽娜 马显钦 侯静波[1] 代建南 于波[1] Zhao Jiawei;Zhao Rui;Fang Chao;Chen Yuzhu;Xu Xueming;Cui Lina;Ma Xianqin;Hou Jingbo;Dai Jiannan;Yu Bo(Department of Cardiology,the Second Affiliated Hospital of Harbin Medical University,State Key Laboratory of Frigid Zone Cardiovascular Diseases(SKLFZCD),the Key Laboratory of Myocardial Ischemia,Chinese Ministry of Education,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第二医院心血管内科、寒地心血管病全国重点实验室、心肌缺血教育部重点实验室,哈尔滨150001

出　　处：《中华心血管病杂志》2024年第6期659-666,共8页Chinese Journal of Cardiology

基　　金：国家自然科学基金(62135002,82322036,82202286)。

摘　　要：目的采用光学相干断层成像(OCT)分析急性心肌梗死患者中具有胆固醇结晶的非罪犯病变的斑块特征,并探讨胆固醇结晶与斑块破裂、斑块愈合之间的关系。方法本研究为回顾性队列研究,纳入2017年1至12月行三支冠状动脉OCT检查的急性心肌梗死患者,根据非罪犯病变中是否存在胆固醇结晶,在病变水平分为胆固醇结晶组和无胆固醇结晶组,行冠状动脉造影和OCT检查,比较2组非罪犯病变的形态学特征。采用广义估计方程log-binomial多因素回归模型评估非罪犯病变胆固醇结晶与斑块破裂和斑块愈合之间的关系。随访截至2023年10月,绘制Kaplan-Meier生存曲线,采用log-rank检验比较胆固醇结晶和无胆固醇结晶2组之间主要不良心血管事件的发生率。结果本研究共纳入173例患者,年龄(56.8±11.6)岁,男性124例(71.7%)。本研究共纳入710个非罪犯病变,胆固醇结晶组102个(14.4%)非罪犯病变,无胆固醇结晶组608个(85.6%)非罪犯病变。造影结果显示胆固醇结晶组病变的最小管腔直径小,直径狭窄率高,病变长度长(P均<0.01)。OCT结果显示,相较于无胆固醇结晶组,胆固醇结晶病变斑块破裂[17.6%(18/102)比4.9%(30/608),P=0.001]及薄帽纤维粥样硬化斑块[31.4%(32/102)比11.5%(70/608),P<0.001]发生率更高,斑块愈合[44.1%(45/102)比25.8%(157/608),P<0.001]、巨噬细胞等易损斑块特征更多。广义估计方程log-binomial多因素回归分析结果显示,非罪犯病变胆固醇结晶与斑块愈合呈正相关(OR=1.583,95%CI:1.004~2.495,P=0.048),但与斑块破裂无关(OR=1.632,95%CI:0.745~3.576,P=0.221)。随访时间为2142(1880,2198)d。非罪犯病变胆固醇结晶与患者的主要不良心血管事件无关(log-rank P=0.558)。结论急性心肌梗死患者中,伴胆固醇结晶的非罪犯病变狭窄程度更重、易损性更高;非罪犯病变胆固醇结晶与斑块愈合的形成密切相关,与斑块破裂无关。Objective To analyze plaque characteristics of non-culprit coronary lesions with cholesterol crystals in patients with acute myocardial infarction(AMI)by using optical coherence tomography(OCT).We also investigated the potential association between cholesterol crystals with plaque rupture and healed plaque at non-culprit segment.Methods This study was a retrospective cohort study.Between January 2017 and December 2017,patients with AMI who underwent 3-vessel OCT imaging were included in this study.Patients were divided into two groups according to the presence or absence of cholesterol crystals at the non-culprit lesions.All patients underwent coronary angiography and OCT examination,and non-culprit plaque characteristics were compared between the two groups.The generalized estimating equation log-binomial multirariate regression model was used to assess the relationship between non-culprit lesions with cholesterol crystals and plaque rupture and plaque healing.The follow-up data collection ended in October 2023.Kaplan-Meier survival curves were plotted,and log-rank tests were used to compare the cumulative incidence of major adverse cardiovascular events between the two groups.Results A total of 173 AMI patients were included(aged(56.8±11.6)years;124 men(71.7%)).Among 710 non-culprit lesions identified by OCT,there were 102(14.4%)in cholesterol crystals group and 608(85.6%)in non-cholesterol crystals group.Compared with non-culprit lesions without cholesterol crystals,those with cholesterol crystals had smaller minimum lumen diameter,severer diameter stenosis,and longer lesion length(all P<0.01).The prevalence of plaque rupture(17.6%(18/102)vs.4.9%(30/608),P=0.001)and thin-cap fibroatheroma(31.4%(32/102)vs.11.5%(70/608),P<0.01)was higher in the cholesterol crystals groups than in the non-cholesterol crystals group.In addition,vulnerable plaque characteristics such as(44.1%(45/102)vs.25.8%(157/608),P<0.01),macrophages were more frequently observed in non-culprit lesions with cholesterol crystals.The generalized

关 键 词：心肌梗死 光学相干断层成像 非罪犯病变 胆固醇结晶 易损斑块 斑块破裂 斑块愈合 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]