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目的:冠状动脉造影显示的单支病变和多支病变,只是粗略地反映了血管腔狭窄的程度和范围,无法反映血管壁病变的具体情况。本试验利用血管内超声检测左主干来阐述上述两类患者冠状动脉粥样硬化病变的特点。方法:129例冠心病患者被入选,分为单支病变组49例,多支病变组80例。所有患者在进行左冠状动脉系统的介入检查和治疗时,给予左主干的血管内超声检查,然后在每间隔1 mm的超声断面上测量血管外腔面积、内腔面积、斑块面积以及钙化角度,再将所有检测断面的相应数值相加,从而得到整个左主干的外腔容积、内腔容积、斑块体积和总的钙化负荷,最后比较在最小内腔面积的血管断面上以及整个左主干,各检测数据在两组间的差别。结果:左主干血管内、外腔和粥样斑块的定量血管内超声方面:无论在最小内腔面积(MLA)部位还是在整个左主干(除斑块面积、血管外腔外),单支病变组的血管外腔面积、血管内腔面积均显著大于多支病变组,斑块负荷均显著低于多支病变组,均有显著性差异(P＜0.05～0.001)。在MLA横断面上,单支病变组的斑块偏心指数显著高于多支病变组(0.46±0.18对0.33±0.22,P=0.001),即前者斑块的偏心程度显著低于后者。在粥样斑块的钙化方面:单支病变组钙化阳性率显著低于多支病变组,均有极显著性差异(P＜0.001)。其次,对钙化角度的定量分析显示,单支病变组患者MLA部位的钙化度数、左主干总钙化度数、最大钙化度数以及平均钙化度数均显著低于多支病变组,均有极显著性差异(P＜0.001)。结论:冠状动脉造影显示的单支和多支病变存在粥样硬化斑块病理结构的显著差异,表现为多支病变的患者斑块负荷更重,钙化几率和钙化程度更高。
Purpose: Coronary angiography shows a single vessel disease and multi-vessel disease, only roughly reflects the extent and scope of vascular stenosis can not reflect the specific circumstances of the vessel wall lesions. This experiment uses intravascular ultrasound to detect the left main stem to explain the above two types of patients with coronary atherosclerotic lesions. Methods: 129 patients with coronary heart disease were enrolled and divided into single-vessel disease group, 49 cases, multi-vessel disease group, 80 cases. All patients underwent left ventricular endocardial ultrasonography during interventional examination and treatment of the left coronary artery system. The area of the vascular lumen, lumen area, plaque area and calcification angle were measured on every 1 mm ultrasound section , And then add the corresponding values of all the test sections, so as to get the total volume of the left main lumen, lumen volume, plaque volume and total calcification load, the last comparison in the minimum lumen vascular area and the entire left main trunk , The test data in the difference between the two groups. Results: Quantitative intravascular ultrasound of the left main intravascular, extracranial and atherosclerotic plaques: no matter in the minimum lumen area (MLA) or in the entire left main (excluding plaque area, extravascular space), single Vascular area and vascular lumen area in the lesion group were significantly larger than those in the multi-vessel lesion group, and the plaque burden was significantly lower in the lesion group than in the multi-vessel lesion group (P <0.05-0.001). In MLA, the eccentricity index of plaque was significantly higher in the single-vessel lesion group than in the multi-vessel lesion group (0.46 ± 0.18 vs 0.33 ± 0.22, P = 0.001). In calcification of atherosclerotic plaque, the positive rate of calcification in single-vessel lesion group was significantly lower than that in multi-vessel lesion group (P <0.001). Second, quantitative analysis of the calcification point showed that the MLA site calcification degree, left main total calcification degree, maximum calcification degree and the average calcification degree were significantly lower in the single-vessel lesion group than in the multi-vessel disease group P <0.001). CONCLUSIONS: There is a significant difference in the pathological structure of atherosclerotic plaque between single-vessel and multi-vessel lesions displayed by coronary angiography. Patients with multi-vessel disease are more plaque-prone, with a higher risk of calcification and calcification.