冠状动脉轻中度狭窄病变的血管内超声特征

Intravascular Ultrasound Characteristics of Plaques in Angiographic Mildly Coronary Stenosis

通过分析病变的结构特点 ,探讨轻中度狭窄病变斑块不稳定的机制。对冠状动脉造影显示轻中度狭窄(直径狭窄率 2 0 %～ 6 0 % ) 6 2例及重度狭窄 2 6例冠心病患者行血管内超声显像检查 ,分析粥样硬化斑块性质及其狭窄程度。结果发现 ,轻中度狭窄患者中软斑块 (6 8.2 %比 15 .4 % ,P <0 .0 1)、薄纤维帽 (6 5 .9%比 7.7% ,P <0 .0 1)显著多于重度狭窄患者 ,并且斑块破裂 (2 8.2 %比 7.7% ,P <0 .0 1)及正性重构 (5 1.8%比 0 % ,P <0 .0 1)也显著多于重度狭窄患者。轻中度狭窄患者偏心斑块检出率显著多于重度狭窄者 (84 .7%比 30 .1% ,P <0 .0 1) ,但钙化少见 (16 .5 %比 84 .6 % ,P <0 .0 1)。结果提示 ,冠状动脉造影轻中度狭窄患者多数具有不稳定性斑块的结构特点 ,这些特点导致轻中度狭窄者容易发生急性冠状动脉综合征。

Aim To investigate the vulnerable mechanism of mildly lesion by analyzing the structural characteristics of plaque. Methods In 62 patients with angiographic mildly coronary stenosis (diameter stenosis 20%～60%) and 26 patients with several stenosis, intravascular ultrasound (IVUS) imaging was performed. The characteristics of the atherosclerosis plaques were analyzed and stenosis rate was calculated. Results Compared with patients with angiographic several stenosis, patients with angiographic mildly lesion had more soft plaque (68.2% vs 15.4%, P<0.01), thin fibrosis cap (65.9% vs 7.7%, P< 0.01), plaque rupture ( 28.2% vs7.7%, P<0.01), and positive remodeling (51.8% vs 0%, P<0.01). Patients with mildly lesion had more eccentric plaques (84.7% vs 30.1%, P<0.01) and less calcification (16.5% vs 84.6%, P<0.01) than those with angiographic several stenosis. Conclusions In the majority of angiographic mildly coronary stenosis, plaques have several structural features of vulnerability. These features may be contributed to acute coronary syndrome.