冠状动脉临界病变患者光学相干断层成像检出分层斑块的临床意义  

Clinical significance of layered plaque in patients with angiographically intermediate lesions

作　　者：张阿莲[1] 范例[1] 卓杨[1] 王敏[1] 范虞琪[1] 顾俊[1] 张家毓 王长谦[1] 张俊峰[1] ZHANG A-lian;FAN Li;ZHUO Yang;WANG Min;FAN Yu-qi;GU Jun;ZHANG Jia-yu;WANG Chang-qian;ZHANG Jun-feng(Department of Cardiology,Shanghai Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine,Shanghai 200011,China;Shanghai Institute of Precision Medicine,Shanghai 200125,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海200011 [2]上海精准医学研究院,上海200125

出　　处：《中国介入心脏病学杂志》2025年第3期155-162,共8页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81970289、82270340);上海交通大学医学院附属第九人民医院生物样本库项目(YBKA202206)。

摘　　要：目的探讨冠状动脉临界病变患者光学相干断层成像(OCT)检出分层斑块的相关风险因素、临床意义及与预后的关系。方法回顾分析2016年11月至2019年10月在上海交通大学医学院附属第九人民医院心内科行冠状动脉造影提示冠状动脉临界病变,并行OCT检查的患者。根据分层斑块检出情况,分为分层斑块组和非分层斑块组。收集比较两组患者临床资料、实验室指标、造影及OCT结果。采用Logistic回归分析分层斑块及临床特征的关系;采用Cox回归分析冠状动脉临界病变患者不良心血管事件的影响因素。结果共入选172例患者,分层斑块组76例,非分层斑块组96例。校正传统危险因素后,男性(OR 2.415,95%CI 1.162~5.020,P=0.018)、糖尿病(OR2.505,95%CI1.137~5.525,P=0.023)和高脂血症史(OR3.590,95%CI1.478~6.333,P=0.003)是分层斑块的独立危险因素。且OCT分析示分层斑块组患者薄纤维帽斑块、巨噬细胞浸润、微血管化、血栓、斑块破裂和内膜夹层比例更高,脂质斑块长度更长,脂质斑块弧度、脂质斑块指数更大(均P<0.05)。校正其他危险因素后,巨噬细胞浸润与分层斑块独立相关(OR 2.106,95%CI1.019~4.353,P=0.044)。Kaplan-Meier生存分析显示,分层斑块组2年靶血管再次血运重建率高于非分层斑块组(Log-rank P=0.030)。Cox回归显示同时具有分层斑块和薄纤维帽斑块特征是不良心血管事件的独立预测因素(HR 5.165,95%CI 1.696~15.727,P=0.004)。结论在冠状动脉临界病变患者中,OCT检出分层病变多伴随其他不稳定斑块特征,提示不良心血管事件风险增加。同时具有分层斑块和薄纤维帽斑块特征是冠状动脉临界病变患者不良心血管事件的独立预测因素。Objective To investigate the risk factors and clinical significance of layered plaques that were detected by optical coherence tomography(OCT)in patients with angiographically intermediate coronary lesions,and relationship with prognosis.Methods This was a signal-center retrospective study focusing on patients whom underwent coronary angiography and OCT.The layered plaque group and non-layered plaque group were divided according to the presence or absence of stratified plaque.Clinical data,laboratory indicators,angiography,and OCT results were collected and compared between the two groups.Using logistic regression to analyze the relationship between stratified plaques and clinical features;Cox regression analysis was used to investigate the influencing factors of cardiovascular adverse events in patients with critical coronary artery disease.Results A total of 172 patients were enrolled,including 96patients in non-layered plaque group and 76 patients in layered plaque group.Male(OR 2.415,95%CI 1.162-5.020,P=0.018),diabetes(OR 2.505,95%CI 1.137-5.525,P=0.023)and history of hyperlipidemia(OR 3.590,95%CI 1.478-6.333,P=0.003)were independent risk factors for stratified plaque.In OCT analysis,the proportion of thin-cap fibroatheroma(TCFA)plaque,macrophage infiltration,microvascularization,thrombosis,plaque rupture,and intimal dissection,as well as lipid plaque length,lipid plaque arc,and lipid plaque index were higher in the layered plaque group.After adjusting for other risk factors,macrophage infiltration is independently associated with stratified plaques(OR 2.106,95%CI 1.019-4.353,P=0.044).Kaplan-Meier survival analysis showed that the target lesion revascularization rate in the layered plaque group was higher than that in the non-layered plaque group(Log-rank P=0.030).Cox regression analysis shows that it has both stratified plaque and thin fibrous membrane plaque characteristics was an independent predictor of cardiovascular adverse events(HR 5.165,95%CI1.696-15.727,P=0.004).Conclusions In patients with angiogra

关 键 词：冠状动脉临界病变 光学相干断层成像 分层斑块 不稳定斑块 

分 类 号：R54[医药卫生—心血管疾病]