冠状动脉易损斑块的血管内超声—虚拟组织学研究

The study of vulnerable plaque in coronary artery using intravascular ultrasound virtual histology

目的应用血管内超声—虚拟组织学技术(IVUS-VH)分析稳定型心绞痛(SAP)和急性冠状动脉综合征(ACS)冠状动脉斑块成分特征。方法 2014年2月—2015年1月心内科诊断及冠心病患者120例,其中SAP患者60例,ACS患者60例,完成冠状动脉造影(CAG)之后,对罪犯病变进行血管内超声检查,保存普通灰阶图像和虚拟组织学超声数据,分析斑块的虚拟组织学特点。结果 ACS组易损斑块检出率明显高于SAP组(81.7%vs.30.0%,P<0.01)。ACS组普通灰阶超声斑块偏心指数(EI)和血管重构指数(R1)大于SAP组(t=-2.985、-3.047,P<0.01),说明ACS组罪犯病变偏心斑块居多,血管重构以正性重构为主。在斑块成分组成上,ACS组以纤维脂质成分(黄色)和坏死成分(红色标记)为主,而SAP组以纤维成分(绿色)和钙化成分(白色标记)为主。结论IVUS-VH在检测不稳定斑块方面有着很高的特异性和敏感性,通过使用IVUS-VH对病变进行分析,有可能会改变冠脉介入治疗的现状。

Objective To analyze the characteristics of stable angina pectoris （ SAP） and acute coronary syndrome （ ACS） coronary plaque composition using intravascular ultrasound virtual histology （ IVUS-VH） .Methods From February 2014 to January 2015, 120 cases of patients with coronary heart disease were enrolled, including 60 cases of patients with SAP, 60 cases of patients with ACS, after the completion of coronary angiography （ CAG） , the culprit lesion were detected by intravascular ultrasound （ IVUS） , save ordinary gray scale image and virtual histology ultrasound data and plaques characteris-tics were analyzed using virtual histology.Results The ACS group plaque detection rate was significantly higher than that of SAP group （81.7%vs.30.0%, P 〈0.01）.ACS group’s ordinary gray scale ultrasound plaque eccentricity index （EI） and vascular remodeling index （RI） were greater than SAP group （ t =-2.985, t =-3.047, P 〈0.01）, most culprit lesion of ACS group were eccentric plaques, vascular remodeling was mainly positive remodeling.In plaque composition, ACS group mainly were fiber lipid composition （ yellow） and necrotic elements （ marked in red） , and SAP group were fiber components （ green） and calcified components （ white label） .Conclusion IVUS-VH in detection of unstable plaque has a very high spe-cificity and sensitivity, using IVUS-VH to analyze lesions may change the current status of the treatment of percutaneous coro-nary intervention.