不同尿酸水平老年冠心病患者血管内超声检查结果比较研究

Serum Uric Acid Level and Plaque Characteristics Assessed by Intravascular Ultrasound in Elderly Patients with Coronary Heart Disease

背景近年相关研究数据表明,高尿酸血症的患病率逐年上升,已成为危害老年人群健康的重大问题。而目前研究证实,高尿酸血症可以导致动脉粥样硬化的发生并增加心血管事件发生风险,降低尿酸水平则可以延缓动脉粥样硬化的进展。目的探讨不同尿酸水平与老年冠心病患者血管内超声(IVUS)检查结果的差异,为冠心病临床治疗提供理论依据。方法选取2015年1月-2018年7月在广西中医药大学第一附属医院心血管内科明确诊断为冠心病且行冠状动脉造影及IVUS检查的患者140例为研究对象。收集患者一般资料、尿酸水平、IVUS检查结果〔血管外弹力膜面积、斑块负荷、斑块面积、斑块纤维帽厚度、斑块偏心指数、斑块最大厚度、斑块最小厚度、斑块钙化类型、脂质池面积、重构指数、平均血管直径及左主干狭窄程度和左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)狭窄程度、脂质池面积/斑块面积〕。根据患者住院期间尿酸水平,将其分为低尿酸水平组(≤199μmol/L,43例)、中尿酸水平组(200~399μmol/L,50例)、高尿酸水平组(≥400μmol/L,47例)。结果三组患者血管外弹力膜面积、斑块负荷、斑块偏心指数、斑块最小厚度、斑块钙化类型、脂质池面积、重构指数、平均血管直径和LAD、LCX、RCA狭窄程度及脂质池面积/斑块面积比较,差异无统计学意义(P>0.05);高尿酸水平组患者斑块面积大于低尿酸水平组、中尿酸水平组(P<0.05);高尿酸水平组患者斑块纤维帽厚度小于低尿酸水平组,斑块最大厚度、左主干狭窄程度大于低尿酸水平组(P<0.05)。结论高尿酸水平的老年冠心病患者冠状动脉斑块以斑块面积大、纤维帽较薄、斑块最大厚度大、左主干狭窄程度高的不稳定性斑块为主,高尿酸水平可能增加冠状动脉不稳定性斑块形成的风险,这类患者的临床治疗应更注重不稳定性斑块的改善与预防。

Background In recent years,research shows that the prevalence of hyperuricemia is increasing year by year,and the disease has become a major health hazard to the elderly.Current studies have confirmed that hyperuricemia can lead to atherosclerosis and increase the risk of cardiovascular events,while lowering uric acid levels can delay the progression of atherosclerosis.Objective To analyze the plaque characteristics assessed by intravascular ultrasound(IVUS)in elderly patients with coronary heart disease(CHD)by serum uric acid level,providing a theoretical basis for clinical treatment of CHD.Methods We enrolled 140 CHD patients with a definite diagnosis of CHD from Department of Cardiovascular,the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2015 to July 2018.All of them were examined by coronary angiography and IVUS.We collected their general information,uric acid level and IVUS results〔area of extravascular elastic membrane,plaque load,plaque area,plaque cap thickness,eccentricity index,maximum plaque thickness,minimum plaque thickness,plaque calcification type,lipid pool area,remodeling index,mean vessel diameter,left main coronary artery stenosis degree,and stenosis degree and lipid pool area/plaque area of left anterior descending branch(LAD),left circumflex(LCX),and right coronary artery(RCA)〕.According to the level of uric acid during hospitalization,the patients were divided into three groups:low uric acid group( ≤ 199 μmol/L,43 cases),medium uric acid group(200-399 μmol/L,50 cases),high uric acid group( ≥ 400 μmol/L,47 cases).Results There were no significant differences in the area of extravascular elastic membrane,plaque load,eccentricity index,minimum thickness of plaque,type of plaque calcification,area of lipid pool,remodeling index,mean vascular diameter,degree of stenosis and area of lipid pool/plaque of LAD,LCX and RCA among high,medium and low uric acid groups(P>0.05).The plaque area of high uric acid group was larger than that of low and medium uric acid groups(P<0.05).High uric acid group had less thickness of fibrous cap of plaque,but greater maximum thickness of plaque and degree of stenosis of left main coronary artery than low uric acid group(P<0.05).Conclusion The IVUS found that elderly CHD patients with high serum uric acid level mainly had unstable coronary plaques with large plaque area,thin fibrous cap,large maximum plaque thickness,and high degree of stenosis of left main coronary artery.High uric acid can increase the risk of unstable plaque formation of coronary artery.So more attention should be given to the improvement and prevention of unstable plaques in clinical treatment of elderly CHD patients with high uric acid.