急性冠状动脉综合征与稳定型心绞痛患者冠状动脉病变的血管内超声比较研究

Intravascular ultrasound study of acute coronary syndrome and stable angina

目的 探讨急性冠状动脉综合征与稳定型心绞痛患者的冠状动脉 (冠脉 )病变血管内超声特征。方法 5 2例急性冠脉综合征患者与 79例稳定型心绞痛患者进行冠脉造影及血管内超声检查 ,根据超声检查结果 ,冠脉病变分为钙化斑块、硬斑块及软斑块。钙化斑块为斑块的回声比血管壁外膜回声强并伴有声影 ,其范围大于 90° ;硬斑块为斑块的回声与血管壁外膜回声大致相同 ,但后方无声影 ;软斑块为斑块的回声比血管壁外膜回声弱。不稳定斑块为纤维帽较薄、有脂质池的斑块或并有斑块破裂。稳定型斑块为钙化斑块及硬斑块。结果 稳定型心绞痛的冠脉病变特点以稳定型斑块为主 ,急性冠脉综合征冠脉病变特点以不稳定型斑块为主。 61.5 %急性冠脉综合征及 3 8.0 %稳定型心绞痛患者为软斑块 ( P <0 .0 1) ,2 8.9%急性冠脉综合征及 6.3 %稳定型心绞痛患者有脂质池 (P <0 .0 1) ,并且急性冠脉综合征患者冠脉斑块多伴有斑块破裂。结论 急性冠脉综合征及稳定型心绞痛的冠脉病变各有自己的特征 ,血管内超声对其有一定的诊断价值。

Objective To investigate the pathologic characteristics of acute coronary syndrome(ACS) and stable angina(SA) through intravascular ultrasound(IVUS). Methods The study consisted of 131 coronary disease patients who underwent coronary artery angiography (CAG)and IVUS, ACS was diagnosed in 52 cases (unstable angina 34 cases and acute myocardial infarction 18 cases) and SA in 79 cases. IVUS examinations: plaque was classified into 3 types according to different ultrasound patterns of tissue reflection. (1) Calcification plaque appeared on ultrasound as an intense characteristic echo reflection with dropout of echoes peripherally, which was termed shadowing. (2)Hard plaque appeared on ultrasound as an intense echo reflection greater than the adventitia echogenicity.(3)Soft plaque appeared on ultrasound as an echo reflection weaker than the adventitia echogenicity. Unstable plaque was lipid-rich pool and thin fibrotic cap and plaque rupture, stable plaque was calcification plaque and hard plaque. Results Patients with ACS had more unstable plaque. 61.5% patients with ACS and 38.0% patients with SA had soft plaque(P< 0.01), 28.9% patients with ACS and 6.3% patients with SA had plaque with lipid pool(P< 0.01). In addition, plaque rupture was found in 21.1% patients with ACS and 1.3% patients with SA (P< 0.01).Conclusions The pathologic characteristics of ACS and SA are different,the IVUS has its value in identifying unstable plaque and stable plaque.