不稳定性心绞痛患者冠状动脉内粥样斑块的稳定性与血栓形成关系的探讨

Exploration on the relationship between thrombosis and stability of coronary atherosclerotic plaque in patients with unstable angina pectoris

目的应用冠状动脉血管内视镜技术对不稳定性心绞痛(unstable angina pectoris, UA)患者的罪犯血管内粥样斑块的稳定性与血栓形成之间的关系进行探讨,为研究急性冠状动脉综合征(acute coronary syndromes, ACS)的发生提供临床病理基础.方法选择UA患者68例,男性48例,女性20例,年龄40～73(62.4±8.6)岁,除外心肌梗死后心绞痛和变异性心绞痛患者.上述患者在进行冠状动脉介入性检查和治疗的同时,对其'罪犯'血管进行血管内视镜检查.结果 (1)68例患者(68支'罪犯'血管)中均观察到粥样斑块(100%),其中有血栓者63例(92.7%),有内膜损伤者46例(67.7%).(2)68例冠状动脉粥样斑块者中,黄色斑块者48例(70.5%),淡黄色斑块者18例(26.5%),白色斑块者2例(2.9%).(3)63例血栓均为附壁性非闭塞性血栓,其中红色或混合性血栓11例(17.5%),白色或粉红色血栓52例(82.5%).(4)46例内膜损伤者中均可见到血栓形成,其中红色或混合性血栓11例(23.9%),白色或粉红色血栓35例(76.1%).结论在UP患者中观察到黄色不稳定性斑块破裂及其伴随的血栓形成,是引起UA的病理基础.因此,在黄色斑块破裂之前采取何种治疗措施使其稳定化,是预防ACS的关键.

Objective To evaluate the correlation between thrombosis and stability of atherosclerotic plaque within criminal vessels in patients with unstable angina pectoris(UAP) by coronary angioscopy, to explore the clinical pathological basis for acute coronary sydromes(ACS).Methods Sixty-eight patients with UAP were enrolled, the patients with post-infarction angina pectoris and variant angina pectoris were excluded. There were 48 males and 20 females, aged from 40 to 73 (average 62.4±8.6) years. The criminal vessels of there patients were observed by coronary angioscopy during percutaneous coronary intervention (PCI) therapy.Results There were 68 criminal vessels in 68 patients. Atherosclerotic plaques were observed in all criminal vessels. Among criminal vessels, thrombi and intimae lesions were detected in 63 cases and 46 cases, respectively. Among 68 cases with atherosclerotic plaques, there were 48 cases of yellow plaques (70.5%), 18 cases of light yellow plaques (26.5%) and 2 cases of white plaques (2.94%). Sixty-three thrombi cases were mural and on-occlusive, which included 11 cases of red or mixed thrombi (17.5%)and 52 cases of white or pink thrombi (82.5%). All intimae lesions were accompanied by thrombosis, which included 11cases of red or mixed thrombi (23.9%) and 35 cases of white or pink thrombi (76.1%). Conclusion The study has shown that the rupture of unstable yellow plaque and its thrombosis were the pathological basis of UAP. Therefore, stabilizing yellow plaque before its rupture may play critical role in prevention and treatment of ACS.