单支临界冠状动脉病变斑块性质的危险因素分析

目的 分析单支冠状动脉临界病变斑块构成及斑块负荷的影响因素.方法 192例经冠脉造影显示单支冠脉临界狭窄病变患者,分为稳定性心绞痛(SAP)组(104例)和不稳定性心绞痛(UA)组(88例),比较两组基线数据的差异;使用iMAP-IVUS测定病变最重处不同斑块的构成比例及斑块负荷等指标,采用单因素及多元线性回归分析各指标的相关预测因子.结果 ①与SAP组比较,UA组的病变血管有更高的外弹力膜面积、斑块面积、斑块负荷、坏死斑块百分比和较低的纤维斑块百分比;②在调整其他危险因子后,糖尿病、脂蛋白相关磷脂酶A2(Lp-PLA2)和低密度脂蛋白胆固醇(LDL-C)是外弹力膜面积、斑块面积及斑块负荷的共同危险因素,而高密度脂蛋白胆固醇是斑块面积和斑块负荷的保护因素;Lp-PLA2与坏死斑块百分比呈正相关性,而与其他斑块成分百分比均呈负相关性;高血压与坏死斑块百分比呈正相关性,与纤维斑块百分比呈负相关性;同型半胱氨酸与坏死斑块百分比呈正相关性;LDL-C与钙化斑块百分比呈负相关性.结论 糖尿病、高血压、Lp-PLA2、同型半胱氨酸和胆固醇水平对冠脉斑块构成及斑块负荷有一定预测价值.

Analysis of the risk factors of plaque quality in single critical coronary artery and intermediate coronary lesions

Objective To investigate the risk factors of plaque burden and atherosclerotic tissue types in single-vessel and intermediate coronary lesions.Methods 192 patients with single vessel and intermediate coronary lesions identified by angiography were enrolled in this study and divided into two groups:stable angina pectoris (SAP) and unstable angina (UA).Using iMAP-IVUS,plaque burden and the percentages of different tissue types in the most severe stegnotic lesions were measured.Single and multiple linear regression analysis were used to analyze the related factors of the above indexes.Results Compared to SAP group,UA group had higher values of areas of plaque and media and vascular external elastic membrane,plaque burden and necrosis percentage,while with lower values of calcified plaque percentage.After adjustment for other risk factors,diabetes,Lp-PLA2 and LDL-C were the common risk factors of plaque burden and cross-sectional areas of plaque and media and vascular external elastic membrane,HDL-C was the protective factor of plaque burden and area of plaque and media.Lp-PLA2 was a strong predictor of necrosis percentage,but with a negative correlation with other plaque tissues percentages.Hypertension was positively correlated with the percentage of necrotic plaque,and it was negatively correlated with the percentage of fibrous tissue.Homocysteine was positively correlated with plaque burden and percentage of necrotic plaque.LDL-C was negatively correlated with the percentage of calcified plaque.Conclusion Diabetes,hypertension,homocysteine,Lp-PLA2 and cholesterol levels have some predictive value for coronary plaque formation and plaque burden.