冠状动脉不稳定斑块的血管内超声影像分析

目的　探讨血管内超声 (intravascularultrasound ,IVUS)判定不稳定斑块的敏感性及特异性。方法　 43例确诊冠心病患者在冠状动脉造影 (coronaryangiography ,CAG)后行IVUS检查 ,根据斑块回声强弱分为软斑块组和硬斑块组 ,两组分别进行定量测定。结果　急性冠状动脉综合征者IVUS检出软斑块 2 2例 (2 2 /2 7) ,占 81.4% ,IVUS检测不稳定斑块的敏感性 81.4% ,特异性 75.0 % ,准确性 79.1% ,阳性预测值 84.6%。软斑块组脂核面积比硬斑块组的无回声区面积明显增大 (P <0 .0 1) ;脂核与斑块比软斑块组明显大于硬斑块组 (2 6.4%± 11.5%对 12 .0 %± 7.0 % ,P <0 .0 1) ;软斑块组纤维帽厚度明显小于硬斑块组 [(0 .3 8± 0 .14 )mm对 (1.17± 0 .3 6)mm ,P <0 .0 1] ;在面积狭窄率上 ,软斑块组明显小于硬斑块组 (62 .6%± 6.9%对 70 .9%± 7.5% ,P <0 .0 1) ;偏心程度软斑块组明显大于硬斑块组 (92 .9%对82 .4% )。两组间斑块大小差异无显著性意义 [(10 .70± 2 .96)mm2 对 (10 .84± 3 .48)mm2 ,P >0 .0 5]。结论　IVUS对冠状动脉不稳定斑块的判定具有较高的敏感性和特异性

Clinical analysis on vulnerable coronary atherosclerotic plaque by intravascular ultrasound

Objective To find out the sensitivity and s pecificity of intravascular ultrasound (IVUS) in identification of unstable atherosclerotic plaques. Methods Fourty-three patients diagnosed coronary heart disease, receiving coronary angiography and intravascular ultrasound examination,were divided into soft plaque and hard plaque group according to the echo reflectivity of atherosclerotic plaque by IVUS. Quantitative determination was performed between the two groups. Results The sensitivity of IVUS in detecting soft plaques from patients with acute coronary artery syndrome was 81.4 %, specificity 75.0 %, accuracy 79.1 %, positive predictive value 84.6 %. The lipid core areas and lipid to plaque ratio of soft plaques were significantly larger than those of hard plaques (P< 0.01 ). The thickness of fibrous cap and area stenosis in soft plaque group was far lower than that in hard plaque group (P< 0.01 ). The superficial and deep calcification deposits in soft plaque group were both lower than those in hard plaque group (P< 0.01 ). The eccentric degree in soft plaque group was more than that of hard plaque group (P< 0.01 ). No difference was found between the plaque size of the two groups (P> 0.05 ).Conclusions IVUS had higher sensitivity and specificity in detecting coronary vulnerable plaques in live bodies.