冠心病患者IVUS-VH下斑块性质与H型高血压的关系

Study on the Relationship Between H-type Hypertension and the Nature of Atherosclerotic Plaque Guided by IVUS-VH in Patients with Coronary Heart Disease

目的利用血管内超声-虚拟组织学(IVUS-VH)技术探讨冠心病患者冠状动脉斑块性质与H型高血压的关系。方法选取我院2011年1月至2014年3月收治的71例高血压合并冠心病的患者为研究对象,其中稳定型心绞痛22例,急性冠状动脉综合征49例,所有患者均行冠状动脉造影检查确诊,冠状动脉造影后对靶病变进行IVUS检查,分析斑块性质及识别ⅣUS-VH下斑块中纤维成分、纤维脂质成分、坏死核心成分及钙化成分。术前测定血浆同型半胱氨酸(Hcy)水平、血脂水平。根据患者是否伴有血Hcy水平升高,分为H型高血压组(Hcy≥10μmol/L,n=42)和非H型高血压组(Hcy<10μmol/L,n=29),分析H型高血压与斑块性质的关系。结果 IVUS灰阶图像分析发现,H型高血压组有软斑块者76.2%,斑块破裂者40.5%,夹层血栓形成者30.9%,均较非H型高血压组(61.7%、13.8%、13.8%)多见(P<0.05)。IVUS-VH图像分析发现,H型高血压组坏死核心成分所占比例显著高于非H型高血压组(23.71%±5.83%比15.37%±2.75%,P=0.000);非H型高血压组钙化成分比例较H型高血压组增高(17.25%±0.26%比9.72%±4.22%,P=0.000)。结论 H型高血压与冠状动脉局部斑块不稳定性有关,H型高血压使冠状动脉局部斑块的易损性增高。

Aim To explore the relationship between H-type hypertension and the nature of atherosclerotic plaque by the technique of intravascular ultrasound-virtual histology( IVUS-VH) in patients with coronary heart disease.Methods 71 patients in our hospital from January 2011 to March 2014 with both hypertension and coronary heart disease were chosen which included 22 samples of stable angina,49 samples of acute coronary syndrome( ACS). Plasma homocysteine( Hcy) and blood lipid were tested in all patients when they were enrolled. And according to the Hcy level,the patients were separated to H-type hypertension group( Hcy ≥ 10 μmol / L,n = 42) and non H-type hypertension group( Hcy < 10 μmol/L,n = 29). Both groups of patients accepted coronary arteriography examination and the atherosclerotic lesions were evaluated by IVUS to analyze the nature of the plaque and to identify the composition of components by IVUSVH: fibrous( F),fibro-fatty( FF),necrotic core( NC) and calcium( CC). At the last,the relationship between Htype hypertension and the plaque 's character was analyzed. Results Compared to the non H-type hypertension group,there were higher proportions of soft plaques( 76. 2% vs 61. 7%,P < 0. 05),plaque rupture( 40. 5% vs 13. 8%,P < 0. 05),sandwich and thrombosis( 30. 9% vs 13. 8%,P < 0. 05) in H-type hypertension group. Analyzed by IVUSVH,there were higher proportions of NC( 23. 71% ± 5. 83% vs 15. 37% ± 2. 75%,P = 0. 000) and lower proportions of CC( 9. 72% ± 4. 22% vs 17. 25% ± 0. 26%,P = 0. 000) in H-type hypertension group than non H-type hypertension group. Conclusion H-type hypertension is associated with the nature of atherosclerotic plaque,and it increases the vulnerability of atherosclerotic plaque in coronary artery.