不同血清尿酸水平的老年冠心病人群血管内超声显像特征分析

目的：研究老年冠心病血管内超声结果，找出其与不同程度尿酸血症的相关性，为老年冠心病临床治疗方案的制定提供数据依据。方法：对自2016年10月—2018年2月期间在我院确诊为冠心病的老年患者进行血管内超声检查，并测量患者血清中尿酸的水平。对两组数据进行回顾性研究分析。结果：纳入的 384 例研究对象根据他们血清尿酸浓度分为低（≤ 199 ummol/L）、中（200 ~ 399 ummol/L）和高（≥ 400 ummol/L）尿酸血症三组。组间比较结果显示血清尿酸浓度的升高对女性基本生理指数无明显影响（P > 0.05），但显著影响了男性患者体重指数、高血压和血脂（P < 0.05）。尽管三组患者在血管外弹力膜面积、脂质池面积、斑块体积、斑块最大/最小厚度和平均血管直径方面相似，但高浓度血清尿酸（高/中尿酸血症）患者斑块的面积显著大于低浓度血清尿酸患者（低尿酸血症）（P < 0.05），而其斑块纤维帽厚度却显著低于低尿酸血症组患者（P < 0.05）。与之相一致，血清尿酸水平的提高增加了钙化冠脉斑块的比例，尤其是深部钙化冠脉斑块的比例。结论: 高血清尿酸老年患者的冠心病斑块呈现不稳定性：纤维帽变薄、斑块面积和钙化现象增加。通过控制血清尿酸浓度来改善冠心病斑块这些不稳定特征将是临床治疗这类患者人群的重点所在

Analysis of intravascular ultrasonographic features of elderly patients with coronary heart disease with different serum uric acid levels

Objective: To study the results of intravascular ultrasound in elder patients with coronary heart disease, as well as to find the correlation between it and uricemia in different degree, and to provide the supporting data to the clinical treatment of elder patients with coronary heart diseases. Methods: The elder patients, who were confirmed with coronary heart disease from October 2016 to February 2018 in the hospital, received the exam of intravascular ultrasound and the measurement of serum uric acid. The correlation between these data were retrospective analyzed. Results: A total of 384 subjects were divided into three groups according to their serum uric acid concentration: low (< 199 ummol/L), medium (200 ~ 399 ummol/L), and high (> 400 ummol/L). The results showed that the elevated serum uric acid concentration had no significant effect on the basic physiological index of female (P > 0.05), but significantly affected the body mass index, hypertension, and blood lipid of male patients (P < 0.05). Although the volume of vascular plaque, the area of extravascular elastic membrane, the area of lipid pool, the maximum/minimum thickness of plaque and the average diameter of blood vessel were similar among the three groups, the area of plaque in patients with high/moderate serum uric acid concentration was significantly larger than that in patients with low serum uric acid concentration (hypouricemia) (P < 0.05). The thickness of the plaque fiber cap is significantly lower than that of the low uric acid group. (P < 0.05). Besides, the increase of serum uric acid led to the higher proportion of calcified coronary plaque, especially deep calcified coronary plaque. Conclusion: The atherosclerotic plaques in elderly patients with high serum uric acid show the unstable characteristics of thinning fibrous cap thickness, enlarging plaque area and aggravating plaque calcification. Improving these unstable characteristics of coronary plaque by controlling serum uric acid concentration will be the focus of clinical treatment for this group of patients