急性冠脉综合征冠脉病变的血管内超声研究_医学论文.docVIP

急性冠脉综合征冠脉病变的血管内超声研究_医学论文 急性冠脉综合征冠脉病变的血管内超声研究_医学论文 作者：王青海 徐会圃 刘现亮 张明哲 刘长梅 王东 李宗清 李景森 程艳丽 张静 【摘要】 目的 探讨急性冠脉综合征冠状动脉罪犯病变的血管内超声（IVUS）特点。方法 对35例稳定型心绞痛（SA）患者和49例急性冠脉综合征（ACS，包括急性心肌梗死和不稳定型心绞痛）患者进行冠状动脉造影（CAG）检查，并应用IVUS观察冠脉罪犯病变处的粥样硬化斑块的性质，同时测量血管外弹力膜面积（EEA）、管腔面积（LA），计算斑块面积（PA）、斑块负荷、偏心指数（EI），并观察血管重构情况。结果 ACS患者冠脉病变处以软斑块为主（69.4%，34 /49) , SA患者冠脉病变处以硬斑块为主（77.1%，27/35) ,差异有统计学意义(P＜0.05),其中ACS组不稳定斑块、内膜破裂和血栓形成病变占总病变的57.2%，与SA组（8.6%）相比具有显著差异性（P＜0.01）；同时两组患者斑块面积［（11.26±3.92） mm2 vs （9.43±3.98）mm2］，斑块负荷［(65.67±11.74）% vs（57.34±11.18）%］,偏心指数（0.33±0.22 vs 0.59±0.24）相比差异亦具有显著性（P＜0.01）；而且，ACS患者主要以正性重构为主（59.2%）,而SA患者主要以负性重构为主（57.1%），二者均有统计学差异（P=0.000，P=0.002）。结论 在ACS组不稳定斑块及内膜破裂、血栓形成、血管正性重构发生率明显高于SA组，IVUS检查是在体观察粥样斑块的良好手段，并可以指导治疗策略。 【关键词】 冠状动脉粥样硬化；心肌梗死；不稳定型心绞痛；超声检测 【Abstract】 Objective To investigate the characteristic of plaques through intravascular ultrasound.Methods Thirthyfive patients with stable angina pectoris ( SA ) and fourtynine patients with acute coronary syndrome (ACS) (included acute myocardial infarction and unstable pectoris) were examined by coronary arteriography(CAG) and intravascular ultrasound ( IVUS). We studied the culprit lesions about the characteristic of the plaque,measured the external elastic membrane crosssectional area and lumen crosssectional area,calculated the plaque area,plaque burden, eccentricity index ,and examind the remodeling index. Results Soft plaques were dominant in ACS patients （69.4%,34/49）,and hard plaques were dominant in SA patients［77.1% (27 /35) ,P＜0.05］.The proportion of instability plaues,ruptured membranes,thrombosis is higher in ACS group. Also, plaque area, plaque burden and eccentricity index were all significantly larger in ACS patients than in SA patients ( all P＜ 0.05).Positive remodeling was more frequent in ACS patients than in SA patients, whereas negative remodeling was more frequent in SA patients (P＜0.05).Conclusion In ACS group, the incidence of plaque vulnerability and rupture,thrombosis,positive remodeling were higher