OCT用于评估年轻人群不稳定型心绞痛患者罪犯斑块的形态学特点

Morphologic Characteristics of Culprit Lesion in Young Patients with Unstable Angina Pectoris: An Optical Coherence Tomography Study

目的:通过光学相干断层成像技术(Optical Coherence Tomography,OCT)观察50岁以下的不稳定型心绞痛(Unstable Angina Pectoris,UAP)患者冠状动脉罪犯斑块的形态学特点。方法:回顾性分析来我院治疗的147名≤50岁的UAP患者资料。所有罪犯血管在进行经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)前都进行了冠脉造影和OCT检查,并评估罪犯斑块的特点。根据罪犯斑块形态学特点分为斑块破裂(Plaque Rupture,PR)组、斑块侵蚀(Plaque Erosion,PE)组和对照组。结果:在147个罪犯斑块中,35个罪犯斑块发生侵蚀(23.8%),42个罪犯斑块发生破裂(28.6%)。人口学、实验室结果显示PE更多发生在女性(60.0%),PR更多发生在男性(69.0%);与PR组和对照组相比,PE组年龄偏大(P<0.001)且高脂血症(P=0.007)和吸烟(P=0.005)比例也较高。OCT结果显示与PE组和对照组相比,PR组脂质核心更长(P=0.002),平均脂质角度更大(P=0.001),且纤维帽厚度较薄(P=0.013)。多因素逻辑回归分析得出,PE的发生与高脂血症和吸烟有关。结论:PR和PE导致了超过半数的50岁以下的UAP发作,PE更多发生在高脂血症和吸烟的UAP患者,已经成为除PR外可能导致心脏不良事件的斑块特征。

Objective:To investigate morphological features of plaque lesion in patients under 50 with unstable angina pectoris(UAP)using optical coherence tomography(OCT).Methods:This retrospective study included 147 UAP patients who were all under 50 years old.All of them were given both angiographic and OCT test on culprit lesions of each before percutaneous coronary intervention(PCI)treatment.According to morphological features of culprit lesions to distinguish whether there is a plaque erosion(PE),plaque rupture(PR),and the control group.Results:We got 35(23.8%)patients/culprit lesions were only with erosion,42(28.6%)patients/culprit lesions were with rupture.In demographic and laboratory findings,PE was more often found in female(60.0%)and PR was more often found in male patients(69.0%).Compared with PR group and control group,PE group was significantly older(P<0.001).In addition,the patients with PE were more frequently with hyperlipidemia(P=0.007)and smoking history(P=0.005).In OCT findings,compared with PE group and control group,the patients with PR were with longer lipid core length(P=0.002),larger mean lipid arc(P=0.001)and thinner fibrous-cap thickness(P=0.013).In multivariable logistic regression model for erosion,we found hyperlipidemia and smoking might be two major factors of incidence of PE.Conclusions:PE and PR contribute to over half of patients under 50 with UAP using OCT.More PE occurred in hyperlipidemia and smoking in patients with UAP.PE became another characteristics of the culprit lesion which could lead cardiac events like PR did.