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目的本研究的目的旨在应用血管内超声显像(IVUS)技术探讨斑块组成与冠状动脉重构之间的关系。方法对77例冠心病患者(男性53例,平均年龄58±10岁)的罪犯血管采用ClearView或Galaxy2(美国波士顿科学公司)血管内超声显像仪进行IVUS检查,其中31例为稳定性心绞痛,46例为急性冠状动脉综合征。对病变进行定性和定量测定。根据斑块组成回声的不同,分为软斑块、纤维斑块、钙化斑块和混合斑块,后三者统称为硬斑块。重构指数(RI)=病变处血管横截面积/平均参考血管面积。若RI>1.0为正性重构;RI<1.0为负性重构。比较不同重构形式病变的特性。结果77处病变中,45处(58%)发生正性重构,32处(42%)发生负性重构。比较两组患者的临床表现,正性重构的患者更多的表现为急性冠状动脉综合征(74%比43%,P=0.006)。与负性重构相比,正性重构病变部位的斑块面积和血管面积较大,斑块组成更多为软斑块(71%比34%,P=0.001),发生钙化的较少(21%比54%,P=0.003),钙化范围也较小[(18±37)°比(40±50)°,P=0.027]。进行多因素回归分析后,斑块组成和临床表现在两组患者中的差别仍具有统计学意义。结论冠状动脉重构与临床表现及斑块组成有关,正性重构病变软斑块较多见且钙化较少。
Purpose The purpose of this study was to explore the relationship between plaque composition and coronary remodeling using intravascular ultrasound imaging (IVUS). Methods The blood vessels of 77 patients with coronary heart disease (53 males, average age 58 ± 10 years) were examined by IVUS with ClearView or Galaxy2 intravascular sonography. Among them, 31 were stable angina, 46 cases of acute coronary syndrome. Qualitative and quantitative determination of lesions. According to the different composition of the patch echo, divided into soft plaque, fibrous plaque, calcified plaque and mixed plaque, the latter three collectively referred to as a hard plaque. Reconstruction Index (RI) = vascular cross-sectional area at lesion / mean reference vascular area. If RI> 1.0 is positive reconstruction, RI <1.0 is negative reconstruction. Comparison of different reconstruction of the characteristics of the lesion. Results Of the 77 lesions, 45 (58%) had a positive remodeling and 32 (42%) had a negative remodeling. Comparing the clinical presentation of the two groups, patients with positive remodeling showed more acute coronary syndromes (74% vs 43%, P = 0.006). Compared with the negative remodeling, plaque area and vascular area of the positive remodeling lesion were larger, the plaque composition more soft plaque (71% vs 34%, P = 0.001), less calcification (21% vs 54%, P = 0.003), with a lesser extent of calcification (18 ± 37 ° versus 40 ± 50 °, P = 0.027). After multivariate regression analysis, the differences in plaque composition and clinical manifestations between the two groups of patients were still statistically significant. Conclusions Coronary artery remodeling is related to clinical manifestations and plaque composition. Positive remodeling soft plaque is more common and less calcified.