早发冠心病急性冠状动脉综合征患者病变血管斑块特点分析

目的 利用iMap血管内超声(iMap IVUS)分析早发冠心病中急性冠状动脉综合征(ACS)患者的病变血管斑块的形态学特点.方法 选择2015年7月至2018年3月诊断为ACS的患者,将<55岁的男性、<65岁的女性分为早发冠心病组29例,>55岁的男性,>65岁的女性;患者分为晚发冠心病组102例,分析两组患者临床资料、实验室检验、冠状动脉造影及IVUS检查结果.结果 早发冠心病组平均年龄(53.07±8.08)岁,晚发冠心病组平均年龄(70.71±8.23)岁(P<0.001).两组冠心病高危因素及检验水平差异无统计学意义.在最小管腔面积分析中,早发冠心病组斑块内纤维成分比例显著高于晚发冠心病组(P<0.001),且坏死成分、钙化成分比例低于晚发冠心病组(P<0.001).在整体斑块分析中,早发冠心病组病变长度显著长于后者(P=0.041),整体斑块结构组成和最小管腔面积一致:高纤维成分(P=0.009),低坏死成分(P=0.020)和低钙化成分(P=0.009).早发冠心病组中薄帽纤维脂质斑块的比例更低(P=0.032).结论 早发冠心病合并ACS患者冠状动脉斑块更为局限,表现为高纤维成分、低坏死和低钙化成分,提示斑块存在一定的可逆性.

Objective To assess the coronary plaque tissue characterization by iMAP-IVUS in premature coronary heart disease patients with acute coronary syndrome. Methods Patients diagnosed premature CHD(males aged<55 years,and females aged<65 years)along with older patients with CHD during June 2015 to March 2018 in this center were enrolled in this study. The cardiovascular risk factors,laboratory examination findings, coronary angiography data,information of IVUS were recorded. Results There were 29 patients in the premature CHD group and 102 patients in later CHD group. The average age was 53.07±8.08 vs. 70.71±8.23 years(P<0.001). There were no significant differences between the two groups in terms of traditional coronary risk factors and laboratory findings. At the minimum lumen site in each plaque,premature CHD appeared to be more fibrotic area(P<0.001),less necrotic area(P<0.001)and significantly less calcified area(P<0.001)than later CHD. At the whole plaque,the plaque composition was similar to minimum lumen site in premature CHD group:more fibrotic(P=0.009)and less necrotic(P=0.020),calcified (P=0.009)components. Compared with later CHD group,the culprit lesion length was shorter(P=0.041),and thin-cap fibroatheroma(TCFA) were lower(P=0.032)in premature CHD group. Conclusions Coronary plaque tissue in premature CHD appears to be more fibrotic and less necrotic,calcified components compared to later CHD,which reveals the reversibility in premature CHD.