血管内超声表现不同的冠状动脉斑块临床特点比较

Clinical characteristics of coronary plaques differentiated by intravascular ultrasound

摘要:

目的 采用血管内超声（IVUS）分析冠心病患者冠状动脉内斑块的临床特点。方法 入选2010年1月至2013年12月在沈阳军区总医院心内科住院并经冠状动脉造影证实的冠心病患者220例，根据IVUS斑块回声强弱分为3组：衰减斑块组（n＝42），钙化斑块组（n＝63）和纤维斑块组（n＝115）。对此220例患者的基线资料和斑块特点进行比较分析。根据IVUS检查结果，确定需行经皮冠状动脉介入治疗（PCI）术的患者有140例（全部成功），其中衰减斑块组26例（PCI比率62%），钙化斑块组41例（PCI比率65%）、纤维斑块组73例（PCI比率63%）。对此140例患者的斑块特点、PCI术特点以及随访情况进行比较分析。结果 钙化斑块组患者年龄较其余两组大（P＜0.05），总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）均显著低于其余两组（P＜0.05）；衰减斑块组患者的既往心肌梗死或冠状动脉搭桥术（CABG）以及吸烟史均显著高于其余两组（P＜0.05）。钙化斑块组的最小管腔面积和病变血管直径显著低于其余两组（P＜0.05)；与其他两组患者相比，衰减斑块组患者的斑块负荷较重、病变血管面积较大（P＜0.05）。在行PCI术的患者中：与其他两组患者相比，衰减斑块组患者的斑块负荷较重（P＜0.05）。行PCI术的各组患者在1年内发生死亡、心肌梗死和再次血运重建的概率间无统计学差异（P＞0.05）。结论 吸烟、既往心肌梗死或CABG史与衰减斑块的发生有关；与钙化斑块组及纤维斑块组相比，衰减斑块组具有较大的斑块负荷；PCI对IVUS证实的不稳定斑块具有较好的治疗效果。

Abstract:

Objective To investigate the clinical characteristics of different plaques detected by intravascular ultrasound (IVUS). Methods From January 2010 to December 2013, 220 patients with coronary heart diseases confirmed by coronary angiography in our department were enrolled in this study. The patients were divided into 3 groups according to the ultrasound echo intensities of plaques in IVUS findings, that is, attenuated plaque group (n＝42), calcified plaque group (n＝63), and fibrous plaque group (n＝115). Their clinical baseline data and IVUS data were analyzed and compared. According to the results of IVUS findings, there were 140 case needing to undergo percutaneous coronary intervention (PCI), including 26, 41 and 73 cases respectively from the attenuated, calcified and fibrous plaque groups, with the ratio of PCI 62%, 65% and 63% in the three groups respectively. All were successful. The plaque types, PCI features and follow-up data were also analyzed in these 140 patients. Results The patients from the calcified plaque group had older age and lower levels of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) when compared with those from the other groups (all P＜0.05). The attenuated plaque group had higher ratios in past histories of smoking, myocardial infarction, and coronary artery bypass surgery (CABG), and larger plaque burden and lesion vessel area when compared with the other 2 groups (all P＜0.05). Minimal lumen area and lesion vessel diameter were obviously smaller in the calcified plaque group than in the other 2 groups (all P＜0.05). For the 140 patients undergoing PCI, those from the attenuated plaque group had higher plaque burden than that from the other 2 groups (P＜0.05), and there were no significant differences in 1-year mortality, incidence of myocardial infarction and ratio of target vessel revascularization from the 3 groups (P＞0.05). Conclusion Past histories of smoking, myocardial infarction and CABG are correlated with the incidence of attenuated plaques. The patients with attenuated plaques have larger plaque burden than those with calcified or fibrous plaques. PCI has satisfactory therapentic effect on unstable plaques detected by IVUS.