冠脉斑块稳定性的影响因素探讨及预后的随访研究

Approach the factors that affect coronary plaque stability and follow-up study of its prognosis

目的:总结影响冠脉斑块稳定性的因素,并对入选对象作为期1年的随访研究。方法:回顾性分析2007年4月至2011年4月就诊于我院,经冠脉造影术确诊为冠心病,并行血管内超声(IVUS)检查的104例患者的临床资料。依据IVUS结果分为不稳定性斑块组(A组)和稳定性斑块组(B组),比较两组间的差异。结果:两组患者一般临床特征无明显统计学差异。冠脉介入术前,A组血清脂蛋白(a)[Lp(a)]明显高于B组[(292.6±139.5)mmol.L-1比(216.9±66.4)mmol.L-1,P=0.001];A组纤维蛋白原明显高于B组[(3.4±0.6)g.L-1比(2.6±0.3)g.L-1,P<0.001];A组超敏C反应蛋白(hs-CRP)明显高于B组[(7.8±6.5)mg.L-1比(1.9±0.9)mg.L-1,P<0.001]。A组中正性重构的比例高于B组(78.8%比5.8%,P<0.001);A组软斑块比例高于B组(38.5%比9.6%,P=0.001)。hs-CRP、Lp(a)及纤维蛋白原与纤维帽厚度呈负相关。平均1年随访期间,A组累积的主要心血管事件有高于B组的趋势(log rankχ2=0.371,P=0.034)。结论:不稳定斑块患者hs-CRP、Lp(a)、及纤维蛋白原明显升高,正性重构、偏心病变较多,且狭窄程度、斑块负荷较重,1年主要心血管事件有高于稳定斑块患者的趋势。

Objective： To summarize the factors that affect plaque stability and a follow-up study for a year. Methods： Retrospectively analyze 104 patients who hospitalized in the affiliated Zhongda hosptal, Southeast University and diagnosed with coronary heart disease by coronary angiography in the time period between April 2007 and April 2011. According to the results of IVUS examination, all patients were divided into two groups, unstable plaque group （group A） and stability plaque group（group B）. Results： There was no statistical difference in two groups on the aspect of general clinical characteristics. Before percutaneous coronary intervention Lp （a） C- reactive protein （ hs- CRP） and fibrinogen in group A was significantly higher than group B（292.6 ± 139.5 vs 216.9 ± 66.4, P =0. 001 ） , （3.4± 0.6vs2.6± 0.3, P〈0.001）, （7.8 ±6.5vsl. 9 ± 0.9, P〈O. O01）. The ratio of positive remodeling in groupA was also higher than group B（78.8% vs 5.8%, P 〈0. 001 ）. Hs-CRP, Lp（a） and fibrinogen was negatively correlated with the fibrous cap thickness. During average 1-year follow-up period, there was a tendency to inerease major adverse cardic events（MACE） rate at 1-year follow-up, which favored group A（log rankx^2 =0. 208, P =0. 034）. Conclusion： （1） hs-CRP, Lp（a）, and fibrinogen significantly increased in unstable plaque group; （2） more positive remodeling eceentric lesions and heavier stenosis, plaque burden was observed in group A ; 3. MACE events of the unstable plaque group trended to increase.