冠状动脉粥样硬化性心脏病单支病变和多支病变的血管壁结构的对比研究

目的:冠状动脉造影显示的单支病变和多支病变,只是粗略地反映了血管腔狭窄的程度和范围,无法反映血管壁病变的具体情况。本试验利用血管内超声检测左主干来阐述上述两类患者冠状动脉粥样硬化病变的特点。方法:129例冠心病患者被入选,分为单支病变组49例,多支病变组80例。所有患者在进行左冠状动脉系统的介入检查和治疗时,给予左主干的血管内超声检查,然后在每间隔1 mm的超声断面上测量血管外腔面积、内腔面积、斑块面积以及钙化角度,再将所有检测断面的相应数值相加,从而得到整个左主干的外腔容积、内腔容积、斑块体积和总的钙化负荷,最后比较在最小内腔面积的血管断面上以及整个左主干,各检测数据在两组间的差别。结果:左主干血管内、外腔和粥样斑块的定量血管内超声方面:无论在最小内腔面积(MLA)部位还是在整个左主干(除斑块面积、血管外腔外),单支病变组的血管外腔面积、血管内腔面积均显著大于多支病变组,斑块负荷均显著低于多支病变组,均有显著性差异(P＜0.05～0.001)。在MLA横断面上,单支病变组的斑块偏心指数显著高于多支病变组(0.46±0.18对0.33±0.22,P=0.001),即前者斑块的偏心程度显著低于后者。在粥样斑块的钙化方面:单支病变组钙化阳性率显著低于多支病变组,均有极显著性差异(P＜0.001)。其次,对钙化角度的定量分析显示,单支病变组患者MLA部位的钙化度数、左主干总钙化度数、最大钙化度数以及平均钙化度数均显著低于多支病变组,均有极显著性差异(P＜0.001)。结论:冠状动脉造影显示的单支和多支病变存在粥样硬化斑块病理结构的显著差异,表现为多支病变的患者斑块负荷更重,钙化几率和钙化程度更高。

Comparison of Vessel Walls Structure in Patients With Single Versus Multiple Coronary Artery Disease

Objective:Coronary artery diseases can be divided into single vessel disease and multi-vessel disease by coronary artery an- giography,which represents only a simple evaluation of degrees and location of stenosis.It can't provide detailed information about the lesions in the vessel wall.To explore the atherosclerotic changes in patients with single and multi-vessel disease,left main coronary artery(LMCA)was examined using intravascular ultrasound(IVUS). Methods:A total of 129 patients with coronary artery disease were enrolled.Among them,49 had single vessel disease and 80 had multi-vessel disease.All the patients underwent IVUS examination of LMCA during interventional procedures of the left anterior descending(LAD)or left circumflex(LCx)coronary artery.Vessel,lumen or plaque area and the angle of calcium arc were measured at each cross section at 1 mm interval in the whole LMCA segment.The volumes of vessel,lumen,plaque and cal- cium were calculated as the sum of the values at each cross section. Results:Patients with multi-vessel disease were older than those with single vessel disease.And there were more hyperten- sive patients in multi-vessel disease group.Quantitative analyses of LMCA showed that compared to single vessel disease group, the external elastic membrane area and the lumen area were remarkably smaller,but the plaque area and calcium arc were remark- ably larger in multi-vessel disease group.The frequency of calcification in multi-vessel disease group was significantly higher. Conclusions:There were significant differences in the atherosclerotic changes between patients with single and multi-vessel diseases.More plaque was detected in multi-vessel disease group.Compared to single vessel disease group,the plaque in multi- vessel disease group was more frequently and severely calcified.