稳定型心绞痛患者与急性冠状动脉综合征患者动脉粥样硬化斑块血管内超声对比

Intravascular Ultrasound Comparison of Atherosclerosis Plaque Between Acute Coronary Syndrome and Stable Angina Pectoris

目的应用血管内超声,对比稳定型心绞痛和急性冠状动脉综合征患者动脉粥样硬化斑块的特点。方法对明确诊断为稳定型心绞痛患者(51例,冠状动脉造影显示病变位于63条血管)以及急性冠状动脉综合征患者(32例,冠状动脉造影显示病变位于46条血管)的动脉粥样硬化斑块形态学特点进行比较。结果两组患者血管内超声发现,软斑块比例、血管重构指数、最小面积处血管外弹力膜面积、最小面积处斑块负荷和斑块破裂急性冠状动脉综合征组高于稳定型心绞痛组(P<0.05);但血栓检出率两组患者差异没有显著性(P>0.05)。结论目前临床工作中,人们只能半定性诊断易损斑块。如检出软斑块且位于重要血管的近端,不论病变的狭窄程度或检查发现任何斑块加正性血管重构和最小管腔面积≤4mm2,为急性冠状动脉综合征患者易损斑块,需要尽早介入干预。

Aim To delineate the plaque morphologic characteristics among stable angina pectoris （ SAP） and acute coronary syndrome （ ACS ） by intravascular ultrasound （IVUS）. Method 51 SAP patients with 63 vessels were recruited and 32 ACS patients with 46 vessels were checked by IVUS. Plaques were divided into soft, fibrous, calcified. The IVUS results of plaque compositions detection were compared between SAP and ACS. Results The ration of soft plaque, extent of remodeling index, external elastic membrane area （ EEMA ） , plaque burden （PB） , plaque rupture increased in ACS group. Thrombosis detection rate were not statisticly different between two groups. Conclusion The criteria of soft plaque located in the proximal part of main coronary branches or any deteeted soft plaque with positive remodeling index and minimal lumen area ≤4 mm^2 predicted the vulnerable plaque in ACS and deserved the aggressive treatment.