冠脉临界病变斑块易损性的血管内超声-虚拟组织学分析

目的]通过血管内超声-虚拟组织学技术对急性冠脉综合征和稳定型心绞痛患者冠状动脉粥样临界斑块进行分析,探讨易损斑块的性质及其临床相关性.方法]冠状动脉造影确诊为临界病变的冠心病患者63例,根据临床症状及实验室检查分为急性冠脉综合症(ACS)和稳定型心绞痛(SA)2组,并对其进行血管内超声-虚拟组织学(intravascular ultrasound-virtual histology,IVUS-VH)研究,分析两组斑块的性质及其与临床血脂水平的相关性.结果]ACS患者易损斑块发生率显著高于SA患者(P＜0.05),斑块沿冠脉成簇状分布,其组成以纤维脂肪组织和坏死成分为主,而SA患者斑块纤维成分和钙化成分较高.2组中纤维脂肪组织与低密度脂蛋白(LDL)呈正相关(r=0.08.P＜ 0.05),与高密度脂蛋白(HDL)呈负相关(r=-0.06,P＜ 0.05).结论]通过IVUS-VH发现,ACS患者易损斑块发生率明显高于SA患者,且斑块成分不同,与临床血脂水平具有相关性.

Clinical study of vulnerable atherosclerotic plaques detection by using intravascular ultrasound-virtual histology

【Objective】To compare the tissue characteristics of the atherosclerotic plaques in acute coronary syndrome（ACS） and stable angina（SA） patients by intravascular ultrasound-virtual histology（IVUS-VH） and assess their clinical correlates with plasma lipoprotein.【Methods】In 32 ACS patients and 31 SA patients,culprit lesions were detected with IVUS-VH to investigate the characteristics of the atherosclerotic plaque and its clinical relevance.【Results】ACS patients presented a significantly higher prevalence of vulnerable plaques than SA patients（P 0.05）.A clear clustering pattern,consisted mainly of fibro-fatty tissue and necrotic core-rich tissue,was seen along the ACS coronaries.There were higher levels of fibrous tissue and dense calcium tissue in SA patients compared to ACS patients.In these two groups,fibro-fatty tissue correlates positively with the plastic LDL levels（r = 0.08,P 0.05）,and negatively with the plastic HDL levels（r = 0.08,P 0.05）.【Conclusion】IVUS-VH identified vulnerable plaques as a more prevalent finding in ACS than SA patients.Combining test of cholesterol levels with detection of the vulnerable plaques via the IVUS-VH analysis is a very useful method in clinical settings.