冠心病患者靶病变钙化特征的研究

The characteristics of target lesion calcification in coronary heart disease

目的观察冠心病患者靶病变钙化的特征,并比较不同临床类型之间的差异。方法连续入选2011年11月至2012年12月于东方医院心内科行冠状动脉造影和血管内超声检查的171例冠心病患者,其中稳定型心绞痛(SAP)30例(SAP组),急性冠状动脉综合征(ACS)141例(ACS组),分析靶病变的钙化类型、分布和长度。结果冠状动脉造影发现,钙化患者48例(28.1%),而IVUS发现钙化患者为122例(71.3%)。按照造影来进行钙化程度的分组,使用IVUS测量的病变长度及斑块负荷,重度钙化组明显大于无或轻度钙化组,且有统计学意义[病变长度:(27.7±12.0)mm比(17.4±8.7)mm,P<0.01;斑块负荷:(70.8±8.1)%比(67.2±7.0)%,P<0.05],而重度钙化组和中度钙化组差异无统计学意义。三组间靶病变外弹力膜面积(EEM-CSA)及最小管腔面积(MLA)差异则无统计学意义。IVUS测定的钙化长度和最大钙化弧度,三组间差异有统计学意义,重度钙化组病变的钙化长度及最大钙化弧度大于其他两组(P<0.05)。SAP组和ACS组之间,在EEM-CSA、MLA、斑块负荷及钙化的发生率方面,差异无统计学意义。但SAP组浅表性钙化与弥漫性钙化的发生率明显高于ACS组,而ACS组深部或混合钙化、点状钙化明显高于SAP组(P均<0.05)。两组最大钙化弧度均值差异无统计学意义,但ACS组病变最大钙化弧度小于90°者高于SAP组(47.5%比26.1%,P<0.05);SAP组钙化弧度在90°以上者高于ACS组(73.9%比52.5%,P<0.05),以上结果ACS的不稳定斑块钙化程度尤其在横断面分布程度低于SAP的靶病变。ACS组IVUS检出存在斑块破裂的18例患者中,17例(94.4%)为点状钙化或混合钙化;ACS组未观察到斑块破裂且存在钙化的81例患者中,点状钙化的发生率仅为45例(55.6%),两组差异具有统计学意义(P<0.01)。结论 IVUS对检出钙化的敏感性远高于冠状动脉造影。与SAP相比,ACS患者靶病变钙化弧度小、深部多见,存在斑块破裂的病变以点状钙化为主。

Objective To observe the frequency and distribution of target lesion calcification in symptomatic coronary artery disease. Methods A total of 171 patients with stable angina（ SAP） or acute coronary syndromes（ ACS） were observed for the calcification in the native target lesion. Both angiography and intravascular ultrasound（ IVUS） was performed to evaluate the frequency,amount and distribution of the target lesion calcification. Results IVUS detected calcium in 122 patients（ 71. 3%）,whereas angiography showed calcification in 48 patients（ 28. 1%）. The length and arc of calcium by ultrasound was greater in the patients with angiographyically visible calcification,the external elastic membrane（ EEM）,minimal lumen area（ MLA） of target lesion have no obvious difference between each angiographyically calcification group. The frequency of calcification has no difference between SAP group and ACS group,but the SAP group had higher frequency of extensive,superficial calcium while ACS group had higher frequency of deep or mixed, spotty calcium. The number of calcium deposits within an arc of 90 ° patient was significantly higher in ACS the in SAP（ 47. 5% vs. 26. 1%,P 0. 05）. IVUS detected 18 plaque rupture in ACS group,which had higher frequency of spotty calcium（ 94. 4% vs. 55. 6%,P 0. 01）. Conclusions Target lesioncalcification is better detected,localized and quantified by intravascular ultrasound than by angiography. The patterns of calcium distribution in the SAP and ACS patients are different. The deep,spotty calcium had higher frequency in the rupture plaque in ACS group.