急性冠状动脉综合征患者不稳定性斑块的血管内超声

目的观察急性冠状动脉综合征患者不稳定性斑块的血管内超声特征.方法 36例急性冠状动脉综合征患者和20例稳定型心绞痛患者进行冠状动脉造影及血管内超声检查.应用血管内超声分别观察比较冠状动脉内斑块的性质,同时测量冠状动脉病变部位及其参考部位的血管外弹力膜面积、管腔面积、斑块面积及管腔面积狭窄率,并计算斑块的偏心指数及血管重构指数.结果急性冠状动脉综合征患者中脂质斑块占77.8%(28/36),其中10例发生斑块破裂及血栓形成;稳定型心绞痛患者主要为纤维性斑块及混合性斑块,脂质斑块仅占10%(2/20),无斑块破裂及血栓形成.两组斑块的特征包括偏心性、外弹力膜面积、斑块面积及管腔面积狭窄率具有显著性差异.不稳定性斑块呈现明显的正性重构,占72.2%(26/36),而稳定性斑块主要表现为负性重构,占75%(15/20).结论血管内超声能够准确地识别动脉粥样硬化不稳定性斑块,为早期临床发现不稳定性斑块并预测斑块破裂奠定了基础.

Intravascular Ultrasonic Features of Unstable Atherosclerotic Plaques in Acute Coronary Syndrome

Aim To identify the characteristic of unstable atherosclerotic plaques in acute coronary syndrome with intravascular ultrasound (IVUS). Methods Thirty-six patients with acute coronary syndrome and twenty patients with stable angina pectoris underwent coronary angiography (CAG) and IVUS examinations respectively. IVUS was used to analyze the qualities of the plaques and then measure the external elastic membrane (EEM) area, lumen area (LA), plaque area (PA) and lumen area narrowing at both the lesion and the reference segments in the same vessel respectively, and lumen eccentricity index and remodeling index were calculated. The characteristic of unstable atherosclerotic plaques were derived by comparing the results of IVUS in the stable and unstable plaques. Results 77.8%(28/36)patients with acute coronary syndrome had soft lipid plaques, ten lesions in ACS patients had plaque rupture and thrombosis; while patients with stable angina pectoris mainly had fibrous and mixed plaques, only 10%(2/20)had soft plaques. There were distinctive difference in eccentric plaques, EEM area, plaque area and lumen area narrowing between the two groups. Positive remodeling pattern was observed in 72.2%(26/36) unstable plaques while 75%(15/20) stable plaques showed negative remodeling. Conclusions IVUS can detect unstable atherosclerotic plaques and predict plaques disruption in early stage of atherosclerosis.