急性冠状动脉综合征患者孤立性和弥漫性斑块的临床研究

目的探讨急性冠状动脉综合征患者冠状动脉孤立性病变和弥漫性病变的不同临床特征。方法从1900例冠状动脉CT检查中连续选择明确诊断急性冠状动脉综合征的患者95例,根据CT结果将患者冠状动脉病变分为孤立性病变(孤立组,61例)和弥漫性病变(弥漫组,34例),比较2组临床特征、CT积分和预后情况。结果与孤立组比较,弥漫组患者年龄更大,高血压、糖尿病、外周血管病、陈旧性心肌梗死、心功能不全的比例更高(P0.05,P0.01);弥漫组患者冠状动脉狭窄积分、病变节段积分、3支病变积分、左主干病变积分、钙化积分均明显增高(P0.05,P0.01)。随访期间,弥漫组患者心血管事件发生率明显高于孤立组(P0.05)。结论以孤立性病变和弥漫性病变区分急性冠状动脉综合征患者可作为临床判定病情和评估治疗效果的参考。

The comparison between discrete plaque and diffuse plaque in acute coronary syndrome

Objective To study the different characteristics between the discrete and diffuse lesions of coronary artery in order to understand coronary plaque pathophysiology in ACS(acute coronary syndrome).Methods CT scan was performed with a dual-source CT scanner or a 64-row slice MDCT(multi-detector CT) scanner.Of the 1900 patients examined,95 satisfied the entry criteria and were divided into 2 groups (discrete plaque group and diffuse plaque group) by CT profile. There were 61(64%) patients in the discrete plaque group and 34(36%) patients in the diffuse plaque group.The clinical characteristics,CT profile and cardiovascular events were compared between the 2 groups.Results Compared with discrete plague group,the patients in the diffuse plaque group were older,had more cases of hypertension,peripheral vascular disease,diabetes,old myocardial infarction and heart failure.The stenosis score,the score of involved segments,3- vessel disease and left main artery disease were less in the discrete lesion group than in the diffuse lesion group.All the 5 patients with STEMI were in the discrete plaque group.In follow up,the incidence of major adverse cardiac events in diffuse plaque group was much higher than that in discrete plague group.Conclusions Distinguishing the discrete and diffuse plaque in ACS patients is useful to assessing the state of illness and prognosis.