冠状动脉粥样硬化病变与冠心病临床表现的关系

Relationship between athcrosclerosis and clinical presentation of coronary heart disease

目的 :研究血管内超声对冠状动脉内斑块形态的分析 ,以及斑块形态、血管重塑与患者临床表现的关系。方法 :2 7例急性冠脉综合征和 17例稳定性心绞痛患者行血管内超声检查 ,定性分析斑块形态和性质 ,测量冠状动脉病变处和近远端参考血管的外弹力膜横截面积 (EEMCSA)、管腔面积、斑块面积和面积狭窄率。结果 :急性冠脉综合征组以软斑块多见 (6 4 9%和 2 9 6 % ,P <0 0 5 ) ,稳定性心绞痛则以纤维斑块更常见 (5 5 6 %和 2 3 5 % ,P <0 0 5 )。EEMCSA :前者为 (14 74± 1 2 3)mm2 ,后者为 (13 4 9± 1 4 8)mm2 (P =0 0 0 4 )。斑块面积 :两组分别为 (11 0 9± 0 94 )mm2 和 (10 10± 0 88)mm2 (P =0 0 0 3) ,而管腔面积和面积狭窄率无显著性差异 (P =0 12和P =0 36 6 )。正性重塑在前者更多见 (5 8 8%和 2 3 5 % ,P <0 0 5 ) ,而负性重塑在后者较常见 (2 5 9%和 5 5 5 % ,P <0 0 5 )。结论 :冠状动脉病变的成分及血管重塑与冠心病临床表现密切相关。

Objective:To establish the relationship among ultrasound derived atheroma morphology,coronary arterial remodeling and clinical presentation of coronary heart disease.Methods:Twenty seven patients with stable angina(SA) and 17 patients with acute coronary syndromes(ACS) underwent intravascular ultrasound(IVUS).Ultrasound images were analyzed for percent of plaque areas and classified into three morphologic subtypes(soft,fibrous,calcific).Quantitative measurements of cross sectional area(CSA) of exteral elastic membrane(EEM),lumen CSA,plaque area and the rate of area stensis.Results:Compared with SA,patients with ACS had more soft lesions(64 09% vs 29 6%,P<0 05),less fibrous lesions(23 5% vs 55 6%,P<0 05).The EEM CSA〔(14 74±1 23)mm 2vs(13 49±1 48)mm 2,P=0 04〕 and plaque CSA〔(11 09±0 94)mm 2vs(10 10±0 88)mm 2,P=0 03〕 were significantly greater at target lesion in patients with ACS than those with SA,while SA,while lumen CSA and percent of area stenosis were no significant difference(P=0 12 and P=0 366).Positive remodeling was more frequent in the patients with ACS(58 8% vs 23 5%,P<0 05),whereas negitive remodeling was more common in those with SA(25 9% vs 55 5%,P<0 05) Conclusion:This study shows that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling and ultrasound calssification of plaque morphology.