急性冠状动脉综合征与稳定性冠心病斑块组织成分的比较

Comparison of coronary plaque composition between patients with acute coronary syndrome and stable coronary artery disease

目的应用血管内超声虚拟组织成像技术评价稳定性冠心病（SCAD）患者与急性冠状动脉综合征（ACS）患者冠状动脉斑块成分的差别，为探讨有效的易损斑块检测方法提供证据。方法入选210例冠心病患者，根据临床表现分为ACS组和SCAD组。对所有直径〉2．5mm的血管内狭窄超过50％的病变行血管内超声检查，共评价346处原位病变。应用虚拟组织学软件分析斑块成分并进行组间比较。结果在ACS与SCAD患者间，总的冠状动脉粥样硬化斑块成分比例差异无统计学意义（纤维组织51．2％±12．5％比52．6％±9．6％，纤维脂肪组织11．3％±10．6％比12．9％±9．4％，钙化组织15．1％±8．9％比20．5％±12．5％，坏死成分23．1％±9．8％比20．4％±6．8％，均P〉0．05）。两组间罪犯病变成分比例差异也无统计学意义（纤维组织49．1％±11．2％比50．3％±9．7％，纤维脂肪组织10．2％±9．5％比12．7％±9．5％，钙化组织15．4％±8．9％比17．4％±24．8％，坏死成分24．0％±11．5％比19．7％±5．3％，均P〉0．05）。ACS患者中，高密度脂蛋白胆固醇〉1．04mmol／L者与≤1．04mmol／L者比较，斑块纤维脂肪成分较多（15．6％±9．6％比7．4％±5．9％，P〈0．05），而坏死成分较少（19．4％±8．6％比28．6％±11．2％，P〈0．05）。结论SCAD与ACS患者冠状动脉粥样硬化斑块中各种成分的比例无明显差别。因此，评价斑块的易损性不仅要看各种成分所占的比例，更重要的是关注不同成分在斑块内的空间分布以及与血管腔的关系。

Objective The purpose of the present study was to compare the plaque composition between patients with acute coronary syndrome （ACS） and stable coronary artery disease （SCAD） by intravascular ultrasound virtual histological analysis. Methods Two hundred and ten patients were divided into ACS group （n = 131, 188 diseased vessels） and SCAD group （n =79, 158 diseased vessels）. A total of 346 de novo lesions with 〉 50% stenosis in native coronary arteries with diameters 〉 2. 5 mm were studied with intravascular uhrasonography. Geometric and compositional data were obtained using intravaseular ultrasound virtual histology software. Results There were no significant differences in overall lesions for fibrous （51.2% ± 12. 5% vs. 52. 6% ±9.6% ） , fibrolipidic （11.3%±10. 6% vs. 12. 9%± 9.4% ）, calcium （15.1% ± 8.9% vs. 20. 5%±12.5% ） or necrotic core （23.1%± 9. 8% vs. 20.4% ±6. 8% , all P 〉0. 05） components between ACS and SCAD patients. Culprit lesions for fibrous （49. 1%± 11.2% vs. 50.3% ±9.7%）, fibrolipidie （10.2%±9.5% vs. 12.7% ±9.5%）, calcium （15.4% ± 8.9% vs. 17.4%±24.8%）, or necrotic core （24.0% ±11.5% vs. 19.7% ±5.3%, all P〉0.05） components were also similar between ACS and SCAD patients. High density lipoprotein-cholesterol （HDL） levels 〉 1.04 mmol/L was associated with more fibrolipidic （ 15.6%±9. 6% vs. 7.4% ±5. 9% ） and less necrotic core （ 19.4% ±8.6% vs. 28.6% ± 11.20/0, all P 〈0. 05 vs. patients with HDL≤1.04 mmol/L） components in ACS patients. Conclusion Coronary plaque composition was similar between ACS and SCAD patients.