冠状动脉粥样硬化病变与冠状动脉重构

Atherosclerosis and Remodeling of the Coronary Artery

目的 :本文旨在通过血管内超声进一步探讨冠状动脉 (冠脉 )粥样硬化斑块与冠脉重构间的关系。 方法 :90例住院病人 ,男 60例 ,女 3 0例 ,年龄 3 6～ 76(5 9± 11)岁。临床诊断冠心病或可疑冠心病。均详细询问病史 ,行心电图、超声心动图、冠脉造影及血管内超声检查。 结果 :①冠脉狭窄与血管重构的关系 :轻 (<5 0 % )、中 (5 0 %～ 75 % )、重 (>75 % )度狭窄均可见血管重构 ,以中、重度狭窄血管重构较明显。但均无明显差异 (P均 >0 0 5 )。②斑块性质与血管重构的关系 :脂质性斑块可见明显的血管重构 ,有显著性差异 (P <0 0 5 ) ,纤维性及钙性斑块血管重构不明显 (P >0 0 5 )。③斑块的形态与血管重构的关系 :61根血管为偏心性斑块 ,3 3根血管为同心性斑块 ,偏心性斑块可见明显的血管重构 ,有显著性差异 (P <0 0 5 )。同心性斑块血管重构不明显 (P >0 0 5 )。 结论 :本文提示血管重构与斑块的性质及形态有着明显的关系 ,偏心性斑块和脂质性斑块可见明显的血管重构 ,而与血管狭窄程度无明显关系。因此 ,由于血管重构 ,血管内超声可显示明显的动脉粥样硬化斑块 ,而冠脉造影可无明显狭窄表现。

Objective:The aim of this study was to assess the relationship between atherosclerosis and remodeling of coronary artery by intravascular ultrasound imaging(IVUS). Methods:Ninety patients, 60 males and 30 females, aged 36 76(59±11)years were stablished, or suspected of coronary artery disease(CAD). Electrocardiography, echocardiography, coronary angiography(CAG) and IVUS were performed in all of the patients. Results:①The relationship between coronary artery stenosis and remodeling:Vessel remodeling was found mild <50%, moderate 50% 75% and severe >75% vessel stenosis, but there was no significant difference.②The relationship between plaque characteristics and vessel remodeling:The vessel sectional area was significantly larger in the lipid plaque vessels than that in the fibrotic plaque and calcium plaque vessels(p>0 05). The vessel sectional areas were 16 71*!mm 2, 13 10*!mm 2 and 13 88*!mm 2 respectively in the lipid, fibrotic and calcium plaques.③Relation of plague morphology to vessel remodeling:The plaque appearance was eccentric in 61vessels and concentric in 34 vessels.A significant vessel remodeling was seen in the eccentric plagues(p>0 05). The eccentric vessel area was larger than the concentric vessel area. Conclusion:Vessel remodeling is apparently seen in the eccentric plaque and lipid plaque. As a result of arterial remodeling, the coronary arteries with marked atherosclerosis on IVUS may appear normal on angiogram.