血管内超声及虚拟组织学评估冠状动脉血管重构与斑块成分的关系

Relationship Between Vascular Remodeling and Plaque Composition Evaluated by Intravascular Ultrasound-Virtual Histology Study

目的应用血管内超声及虚拟组织学技术检测冠心病患者的冠状动脉重构与斑块成分之间的关系。方法对41例冠心病患者行血管内超声及虚拟组织学检查,根据其重构指数分为正性重构组(n=19)及负性重构组(n=22),检测并比较两组的斑块负荷、血管面积、管腔面积以及斑块成分等。结果与负性重构组比较,正性重构组最小管腔处血管面积(17.95±4.25 mm^2比11.44±2.13 mm^2)、管腔面积(6.02±1.85 mm^2比4.98±1.06 mm^2)、斑块负荷(63.83%±7.89%比63.83%±7.89%)均显著增大(P<0.05)。虚拟组织学显示正性重构组比负性重构组坏死成分比例增加(30.38%±9.33%比17.19%±11.31%,P=0.001)、纤维成分比例减少(44.61%±14.93%比61.08%±14.81%,P=0.002),钙化和纤维脂质比例无明显差异(P>0.05)。重构指数与坏死成分比例呈正相关(r=0.373,P=0.023)。结论冠状动脉的正性重构伴随着坏死核心增加,正性重构可能是冠状动脉斑块不稳定的表现。

Aim To evaluate relationship between positive vascular remodeling and plague composition in culprit coronary artery. Methods The study analyzed 41 patients with coronary artery disease that underwent intravascular ultrasoundvirtual histology examination in a culprit lesion. Patients were divided into positive remodeling（PR） group or negative remodeling（NR） group according to remodeling index（RI）. Results Compared with negative remodeling patients,patients with positive remodeling had bigger EEM area（17. 95 ± 4. 25 mm-2 vs 11. 44 ± 2. 13 mm-2）,luman area（6.02 ±1.85 mm-2 vs 4. 98 ± 1.06 mm-2）,and plague burden（63.83% ±7.89 % vs 63.83% ±7.89%; P〈0.05）. Virtual histology analysis showed PR group had higher necrotic core（30. 38% ± 9. 33% vs 17. 19% ± 11. 31%; P = 0. 001） and lower fibrous ratio（44. 61% ± 14. 93% vs61. 08% ± 14. 81%; P = 0. 002） than NR group. There were no significant difference in calclium area and fibrous-fatty area between the two groups. RI showed significant positive correlation with necrotic core（r = 0. 373,P = 0. 023）. Conclusions Positive remodeling in a culprit lesion is associated with the increased ratio of necrotic core.Positive remodeling may be one characteristic of plaque vulnerability.