虚拟组织学成像血管内超声在冠心病临床治疗中的应用进展

Progress of the Use of Virtual Histology Intravascular Ultrasound in the Study of Treatment of Coronary Artery Disease

虚拟组织学成像血管内超声的特点是可以对冠状动脉的斑块进行实时组织学分析。利用这一技术对冠心病患者的研究提示:虚拟组织学成像血管内超声显示的坏死核大、坏死核和管腔直接接触、没有纤维帽的斑块多见于急性冠状动脉综合征患者,也多见于急性冠状动脉综合征患者的直径狭窄<50%的非罪犯血管段,而且冠状动脉的近段斑块坏死核较大;药物洗脱支架没能减少斑块的脂核,且在较长的时间内影响着内皮新生;斑块中大的坏死核与介入治疗时的无复流有关;系列研究显示,他汀治疗可以减少斑块脂质成分,增加纤维组织。

The virtual histology intravascular ultrasound is characterized by the real-time histological analysis f coronary artery plaque.The use of such technique in coronary heart disease patients suggest that on the virtual histology intravascular ultrasound acute coronary syndrome patients are more frequently complicated with large necrotic core in close contact with the lumen in the absence of fibrous cap.Such plaques also frequently occur in nonculprit arteries with a stenosis less than 50% in diameter for acute coronary syndrome patients,showing a larger necrotic core in proximal arterial plaque.The drug-eluting stent fails to reduce the lipid core and impairs the neogeneration of endothelia in a relative long period.The large necrotic core is associated with the absence of reperfusion during the interventional therapy.The series of studies show that statins decrease the lipid content in plaque but increase that of fibrous tissues.