冠状动脉斑块特点与药物支架置入术后斑块脱垂关系的血管内超声研究

Relation between coronary plaque morphology and plaque prolapse after drug-eluting stent implantation： an intravascular ultrasound study

目的探讨冠状动脉斑块特点与药物支架置人术后斑块脱垂的关系。方法对106例冠心病患者行支架置入前、后血管内超声检查，根据支架置入后是否发生斑块脱垂分为斑块脱垂组（44例）和无斑块脱垂组（62例）。结果44例患者的51处斑块脱垂病变和62例患者的89处无斑块脱垂病变纳入分析。斑块脱垂组支架置人数目[（1．5±0．6）比（1．1±0．3），P〈0．001]、长度[（31±13）mm比（21±8）mm，P〈0．001]以及扩张压力[（15．3±2．6）atm比（14．1±2．1）atm，P〈0．001]明显高于无斑块脱垂组，斑块面积明显大于无斑块脱垂组[（13±4）mm。比（11±3）mm^2，P=0．024]，正性重构[（76．5％（39／57）比56．2％（50／89），P=0．016]、斑块破裂[33．3％（17／51）比18．0％（16／89），P=0．039]和超声衰减斑块[84．3％（43／51）比42．7％（38／89），P〈0．01]的比例也均高于无斑块脱垂组。多因素回归分析显示，超声衰减斑块[比值比（OR）=2．361，95％置信区间（CI）：1．107～4．375，P=0．003]和支架长度（OR=1．722，95％CI：1．025～2．973，P=0．015）是斑块脱垂的独立预测因子。结论药物支架置人后斑块脱垂发生率约为36．4％（51／140），超声衰减斑块和支架长度是斑块脱垂的独立预测因子。

Objective To evaluate the relationship between coronary plaque morphology and plaque pro- lapse（ PP ） after drug-eluting stent （DES） implantation assessed by intravascular ultrasound （IVUS）. Methods The study group consisted of 106 patients who underwent DES implantation and pre- and post-stenting IVUS. Results Forty-four patients had 51 PP lesions and 62 patients had 89 non-PP lesions. The PP lesions had more stent number [（1.5±0.6） vs （1.1±0.3）, P〈0.001], longer stentlength [（31 ±13）mm vs （21 ± 8 ） ram, P 〈 0. 001 ] and higher inflation pressure [ （ 15.3 ± 2.6） atm vs （ 14.1 ±2.1 ）atm, P 〈 0.001 ] compared with non-PP lesions. Plaque area [ （ 13 ± 4） mm2 vs （ 11 ±3 ） mm^2, P = 0. 024 ] was larger in PP lesions than in non-PP lesions. Positive remodeling [ （76.5% （39/57） vs 56.2% （50/89）, P =0.016], plaque rupture [33.3% （ 17/51 ） vs 18.0% （ 16/89）, P = 0. 039 ] and attenuated plaque [ 84.3% （43/51） vs 42.7% （ 28/89 ）, P 〈 0. 001 ] were significantly more often in PP lesions than in non-PP lesions. Attenuated plaque [ odds ratio （OR） = 2.361,95% confidence interval （CI） ： 1. 107-4. 375, P = 0. 003] and stent length （ OR = 1. 722, 95% CI： 1. 025-2. 973, P = 0. 015 ） were independent risk predictors for PP. Conclusions PP occurs in 36. 4% of coronary lesions after DES implantation. Attenuated plaque and stent length are independent risk predictors for PP.