应用光学相干断层扫描技术探究点状钙化特征与斑块稳定性的关系

Relationship between spotty calcification and plaque stability in patients with coronary heart disease:an optical coherence tomography study

目的:应用光学相干断层扫描(OCT)技术对冠心病(CHD)患者冠状动脉(冠脉)内点状钙化的形态学特征进行定量检测,并进一步探究这些特征与斑块破裂的关系。方法:分析2019年1月—2021年1月于昆明医科大学第二附属医院心内科就诊行冠脉造影(CAG)及OCT检查的CHD患者共101例,根据OCT检查有无斑块破裂,将101例CHD患者分为斑块破裂组43例与斑块未破裂组58例,探究点状钙化的形态学特征与斑块破裂之间是否存在相关性。结果:点状钙化与斑块破裂呈正相关性(r=0.31,P<0.01),点状钙化的弧度、深度与斑块破裂的发生均呈负相关性(r=-0.62、-0.77,均P<0.01)。多因素logistic回归分析结果提示,点状钙化的弧度(OR:0.96,95%CI:0.94~0.99,P=0.011)与深度(OR:0.94,95%CI:0.91~0.97,P<0.001)与斑块破裂的发生独立相关。结论:OCT所见的冠脉内点状钙化的定量特征与斑块稳定性有明确的关系,即点状钙化的弧度越小、深度越浅,斑块倾向于不稳定,越容易发生斑块破裂。点状钙化可作为新的易损斑块表型,促进斑块破裂,需要引起足够的临床重视。

Objective:To quantitatively detect the morphological features of spotty calcification in patients with coronary heart disease(CHD)using optical coherence tomography(OCT),and to further explore the relationship between these features and plaque rupture.Methods:A total of 101 patients with CHD who received coronary angiography(CAG)and OCT examination in the Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University from January 2019 to January 2021 were retrospectively analyzed.According to the presence or absence of plaque rupture under OCT examination,43 patients were divided into the ruptured plaque group and 58 patients were divided into the unruptured plaque group.The correlation between the morphological characteristics of spotty calcification and plaque rupture was analyzed.Results:The presence of spotty calcification was positively correlated with plaque rupture(r=0.31,P<0.01),and the arc and depth of spotty calcification were negatively correlated with plaque rupture(r=-0.62,-0.77,both P<0.01).Multivariate logistic regression analysis indicated that the arc(OR:0.96,95%CI:0.94 to 0.99,P=0.011)and depth(OR:0.94,95%CI:0.91 to 0.97,P<0.001)of spotty calcification were associated with the occurrence of plaque rupture independently.Conclusion:There is a clear relationship between the quantitative characteristics of spotty calcification detected by OCT and plaque stability.The smaller the arc and the shallower the depth in spotty calcification,the plaque tends to be unstable and more prone to rupture.As a new vulnerable plaque phenotype,spotty calcification can promote plaque rupture,which needs to be paid enough attention by clinicians.