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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)mm2vs(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。
Objective To investigate the characteristics of intravascular ultrasound (IVUS) of coronary artery disease in patients with acute coronary syndrome. Methods Coronary angiography (CAG) was performed in 35 patients with stable angina pectoris (SA) and 49 patients with acute coronary syndrome (ACS, including acute myocardial infarction and unstable angina pectoris) and coronary angiography (EEA) and lumen area (LA), plaque area (PA), plaque load and eccentricity index (EI) were measured at the same time. The blood vessel weight Structure conditions. Results The main coronary lesion in ACS patients were soft plaque (69.4%, 34/49). The main lesion of coronary artery in SA patients was mainly with plaque (77.1%, 27/35), the difference was statistically significant (P <0.05 ), In which unstable plaque, rupture of endometrium and thrombosis lesions accounted for 57.2% of the total lesions in ACS group, which was significantly different from that in SA group (8.6%) (P <0.01). At the same time, plaque area (11.26 ± 3.92 mm2 vs 9.43 ± 3.98 mm2), plaque burden (65.67 ± 11.74)% vs (57.34 ± 11.18)%, and eccentricity index (0.33 ± 0.22 vs 0.59 ± 0.24) (59.2%) in patients with ACS, and negatively remodeled patients (57.1%) in SA patients, both of which were significantly different (P <0.01) = 0.000, P = 0.002). Conclusions The incidence of unstable plaque, endometrial rupture, thrombosis and positive vascular remodeling in ACS group is significantly higher than that in SA group. IVUS examination is a good method to observe atherosclerotic plaque in vivo and can guide the treatment strategy.