IVUS-VH评价ACS患者冠脉粥样硬化斑块成分

Assessment of coronary atherosclerotic plaque by IVUS-VH in patients with ACS

目的利用血管内超声-虚拟组织学(intravascular ultrasound-virtual histology,IVUS-VH)评价急性冠脉综合征(acute coronary syndrome,ACS)患者冠状动脉粥样硬化斑块的成分。方法对38例ACS患者行冠状动脉造影(coronary angiography,CAG)检查发现91处狭窄程度≥50%的粥样硬化斑块,同时对91处病变行IVUS-VH检查,识别其中的纤维成分(fibrous,F)、纤维脂质成分(fibro-fatty,FF)、坏死核心成分(necrotic core,NC)、钙化成分(calcium,CC)。并将91处粥样硬化斑块分为罪犯病变与非罪犯病变,比较两者斑块成分的差异。结果91处斑块中F、FF、NC、CC所占的比例分别为:51.5%±10.8%、15.7%±8.1%、18.7%±9.1%、14.1%±8.8%。91处斑块中43处(47.3%)为罪犯病变,48处(52.7%)为非罪犯病变。两者F和FF相比均无显著差异(53.3%±10.5%vs 49.9%±10.9%,P=0.134;14.0%±9.2%vs 17.2%±6.8%,P=0.062)。罪犯病变与非罪犯病变相比NC所占比例较高(21.9%±10.2%vs 15.7%±6.9%,P<0.05)。非罪犯病变与罪犯病变相比所含CC较高(17.2%±9.7%vs 10.7%±6.1%,P<0.05)。结论IVUS-VH可以定量分析冠状动脉粥样硬化斑块内各种成分。ACS患者斑块中NC与斑块的易损性有关。

Objective To assess coronary atherosclerotic plaque by intravascular ultrasound-virtual histology 0VUS-VH） in patients with acute coronary syndrome （ACS）. Methods A total of 38 ACS patients underwent coronary angiography （CAG）, and 91 coronary atherosclerotic plaques with i〉 50% stenosis found. These plaques were detected by IVUS-VH to identify the composition of components： fibrous （F）, fibro-fatty （FF）, necrotic core （NC） and calcium （CC）. Meanwhile, these plaques were classified as culprit lesion and non-culprit lesion. Then the composition of lesions were compared between them. Results In 91 coronary atherosclerotic plaques, percentages of F, FF, NC and CC were 51.5%±10.8%, 15.7%＋8.1%, 18.7%±9.1% and 14.1%±8.8% respectively. There were 43 （47.3%） culprit lesions and 48 （52.7%） non-culprit lesions in 91 plaques. There were no significant differences in F and FF percentages beween the two lesions （53.3%＋10.5% vs 49.9%±10.9%, P=0.134;14.0%＋9.2% vs 17.2%±6.8%, P=0.062）, respectively. Compared with non-culprit lesions, culprit lesions contained more NC percentages significantly（21.9%±0.2% vs 15.7%±6.9%, P〈0.05）. Non-culprit lesions had more CC percentages significantly （17.2%±9.7% vs 10.7% ±6.1% , P 〈0.05）, compared with culprit lesions. Conclusion IVUS-VH can quantitatively analyze the composition of coronary atherosclerotic plaques. The percentages of NC is related to the vulnerability of the plaque in ACS patients.