冠状动脉重构对心绞痛患者介入治疗预后影响的研究  

Effect of pre-interventional coronary remodeling on outcomes of percutaneous balloon angioplasty in patients with angina pectoris

作　　者：陈绍良[1] 周陵 段宝祥[1] 叶飞[1] 方五旺 贾海波 林松 

机构地区：[1]南京医科大学附属南京市第一医院心内科,210006 [2]南京市心脏介入中心

出　　处：《中华超声影像学杂志》2003年第6期329-332,共4页Chinese Journal of Ultrasonography

基　　金：南京市卫生局重点资助科研课题 (NW2 0 0 0 1 7)

摘　　要：目的　研究不同血管重构类型对单纯球囊扩张的影响。方法　采用冠状动脉内超声对 76例心绞痛患者 (不稳定型 3 7例 ,稳定型 3 9例 )在球囊扩张前、扩张后即刻及术后 3个月时连续观察。对发生再狭窄的患者进行切割球囊成形术和血管内放射治疗。结果　 76例患者中具有典型血管正向重构(VPR)的患者 3 7例 ,非正向重构 (NPR)的患者 3 9例 ,两组年龄及性别等参数之间的差异无显著性意义( P >0 .0 5 )。VPR患者的重构指数 (PR) [1.40± 0 .13 )mm2 ]大于NPR组 [( 0 .79± 0 .11)mm2 ] ;VPR的总发生率为 49% ,这一部分患者中冠状动脉内超声下不稳定斑块的检出率为 70 % ( 2 6/ 3 7) ,后者中脂肪核的检出率为 46% ( 12 / 2 6) ,尤其以近 2 4h内具有静息心绞痛 ( 14例 )的患者多见 ( 9/ 14 ,64 % ) ;VPR组术后 3个月时血管外弹力膜面积增加值 [( -0 .2 5± 1.13 )mm2 ]明显小于NPR组 [( 0 .40± 1.2 3 )mm2 ] ,而血管腔截面积丢失值 [( -1.5 7± 0 .14 )mm2 ]明显大于NPR组 [( -0 .88± 0 .12 )mm2 ] ,再狭窄率高于NPR组。两组再狭窄病变在血管内照射时痉挛的发生率较高 ,且以VPR组最明显 ( 70 % )。再狭窄主要见于病变的近端边缘处。结论　冠状动脉超声下VPR组轻中度狭窄患者斑块多为不稳定型 ,VPR组单纯球囊扩?Objective To study the effect of pre interventional coronary remodeling on percutaneous coronary angioplasty in patients with angina pectoris. Methods Seventy six consecutive patients with coronary artery stenosis >70% were enrolled into the study. Intravascular ultrasound (IVUS) was used before procedure, immediately after the final inflation of balloon and at the time of 3 month follow up. Cross sectional area(CSA) at the site of lesions, proximal and distal reference segment(vessel CSA,lumen CSA, plaque CSA) and remodeling ration were calculated respectively. Percutaneous cutting balloon angioplasty and intravascular irradiation was adopted to treat restenotic lesions during 3 month follow up period. Results Thirty seven of 76 cases had positive remodeling .There was no difference in the age, gender and other clinical parameters between positive and non positive remodeling(39 cases) groups. The remodeling ration in positive group [( 1.40 ± 0.13 )mm 2] was larger than that in the control group [( 0.79 ± 0.11 )mm 2,P< 0.01 ],with total incidence of positive remodeling 49% in 76 patients.IVUS demonstrated 12 lesions(48%)with fatty nucleus in 26 patients(70%) having unstable plaque. Of 26 cases with unstable plaque, fatty nucleus plaque was more common in patients with rest angina(9/14, 64%). At 3 month follow up,the increasing of vessel CSA in positive group [( -0.25 ± 1.13 )mm 2] was smaller than control arm[( 0.40 ± 1.23 )mm 2,P< 0.001 ], but the former had higher value of late loss in lumen CSA[( -1.57 ± 0.14 )mm 2 vs ( -0.88 ± 0.12 )mm 2,P< 0.001 ] and higher incidence of restenosis within 3 months. Cutting balloon angioplasty and intravascular induced spasm commonly in patients with positive remodeling at the site of proximal marge of restenotic lesions where was the common site for re restenosis. Conclusions Unstable plaque is more common in patients with positive remodeling by IVUS and mild to moderatestenosis by angiography.

关 键 词：冠状动脉重构 心绞痛 介入治疗 预后 球囊扩张 经皮冠状动脉内血管成形术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R571.3[医药卫生—诊断学]