陈静怡,姜述斌,张保俭

• 1:新疆医科大学第四临床医学院
• 2:新疆医科大学附属中医医院冠心病重症监护科

摘要(Abstract)：

冠心病是一种常见的心血管病，腔内影像学在冠心病的诊疗中发挥着重要作用。目前临床实践中，血管内超声（IVUS）和光学相干断层成像（OCT）已广泛使用，近红外光谱成像（NIRS）因能敏感地识别脂质成分而备受关注，近年来已有一些应用报道，且仍在不断探索。因脂质在动脉粥样硬化斑块稳定性评估中作用突出，并且影响冠心病的进展及预后。故本文将对目前NIRS技术在冠心病诊疗中的应用作一综述，以进一步为临床疾病诊治、评估及多模态技术的发展提供影像学依据。

关键词(KeyWords)： 近红外光谱成像;富脂斑块;冠心病;主要不良心血管事件;降胆固醇治疗;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目(82160050)

作者(Author): 陈静怡,姜述斌,张保俭

参考文献(References)：

• [1]国家心血管病中心,中国心血管健康与疾病报告编写组,胡盛寿.中国心血管健康与疾病报告2023概要[J].中国循环杂志,2024,39(7):625-660.DOI:10.3969/j.issn.1000-3614.2024.07.001.
• [2]Vrints C,Andreotti F,Koskinas KC,et al.2024 ESC Guidelines for the management of chronic coronary syndromes[J].Eur Heart J,2024,45(36):3415-3537.DOI:10.1093/eurheartj/ehae177.
• [3]刘耀琨,郑博,霍勇.冠心病领域临床研究2023年度进展[J].中国介入心脏病学杂志,2024,32(1):24-31.DOI:10.3969/j.issn.1004-8812.2024.01,006.
• [4]Lugo-Gavidia LM,Alcocer-Gamba MA,Martinez-Cervantes A.Challenges and advances in interventional cardiology for coronary artery disease management[J].Medicina(Kaunas),2024,60(8):1323.DOI:10.3390/medicina60081323.
• [5]Lawton JS.Tamis-Holland JE,Bangalore S,et al.2021 ACC/AHA/SCAI Guideline for coronary artery revascularization:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].Circulation,2022,145(3):e18-e114.DOI:10.1161/CIR.0000000000001038.
• [6]张茜,叶豪奕,崔思美,等.动脉粥样硬化易损斑块分子影像探针研究:进展、挑战与展望[J].中国介入心脏病学杂志,2025,33(4):215-221.DOI:10.3969/j.issn.1004-8812.2025.04.005.
• [7]R?ber L,Ueki Y,Otsuka T,et al.Effect of Alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction:the PACMAN-AMI randomized clinical trial[J].JAMA,2022,327(18):1771-1781.DOI:10.1001/jama.2022.5218.
• [8]Kini AS.Effect of evolocumab on coronary plaque characteristics in stable coronary artery disease:a multimodality imaging study(the YELLOWⅢstudy)[R].New Orleans:American College of Cardiology(ACC)2023 Annual Scientific Sessions,2023.
• [9]Caplan JD,Waxman S,Nesto RW,et al.Near-infrared spectroscopy for the detection of vulnerable coronary artery plaques[J].J Am Coll Cardiol,2006,47(8 Suppl):C92-C96.DOI:10.1016/j.jacc.2005.12.045.
• [10]Gardner CM,Tan H,Hull EL,et al.Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system[J].JACC Cardiovasc Imaging,2008,1(5):638-648.DOI:10.1016/ijcmg.2008.06.001.
• [11]Waxman S,Dixon SR,L'Allier P,et al.In vivo validation of a catheter-based near-infrared spectroscopy system for detection of lipid core coronary plaques:initial results of the SPECTACL study[J].JACC Cardiovasc Imaging,2009,2(7):858-868.DOI:10.1016/j.jcmg.2009.05.001.
• [12]Moreno PR,Lodder RA,Purushothaman KR,et al.Detection of lipid pool,thin fibrous cap,and inflammatory cells in human aortic atherosclerotic plaques by near-infrared spectroscopy[J].Circulation,2002,105(8):923-927.DOI:10.1161/hc0802.104291.
• [13]Kubo T,Terada K,Ino Y,et al.Combined use of multiple intravascular imaging techniques in acute coronary syndrome[J].Front Cardiovasc Med,2022,8:824128.DOI:10.3389/fcvm.2021.824128.
• [14]Madder RD,Husaini M,Davis AT,et al.Detection by near-infrared spectro scopy of large lipid cores at culprit sites in patients with non-ST-segment elevation myocardial infarction and unstable angina[J].Catheter Cardiovasc Interv,2015,86(6):1014-1021.DOI:10.1002/ccd.25754.
• [15]Madder RD,Puri R,Muller JE,et al.Confirmation of the intracoronary near-infrared spectroscopy threshold of lipid-rich plaques that underlie ST-segment-elevation myocardial infarction[J].Arterioscler Thromb Vasc Biol,2016,36(5):1010-1015.DOI:10.1161/ATVBAHA.115.306849.
• [16]Waksman R,Di Mario C,Torguson R,et al.Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging:a prospective,cohort study[J].Lancet,2019,394(10209):1629-1637.DOI:10.1016/S0140-6736(19)31794-5.
• [17]Terada K,Kubo T,Kameyama T,et al.NIRS-IVUS for differentiating coronary plaque rupture,erosion,and calcified nodule in acute myocardial infarction[J].JACC Cardiovasc Imaging,2021,14(7):1440-1450.DOI:10.1016/j.jcmg.2020.08.030.
• [18]Goldstein JA,Maini B,Dixon SR,et al.Detection of lipidcore plaques by intracoronary near-infrared spectro scopy identifies high risk of periprocedural myocardial infarction[J].Circ Cardiovasc Interv,2011,4(5):429-437.DOI:10.1161/CIRCINTERVENTIONS.111.963264.
• [19]Stone GW,Maehara A,Muller JE,et al.Plaque characterization to inform the prediction and prevention of periprocedural myocardial infarction during percutaneous coronary intervention:the CANARY trial(Coronary Assessment by Near-infrared of Atherosclerotic Rupture-prone Yellow)[J].JACC Cardiovasc Interv,2015,8(7):927-936.DOI:10.1016/j.jcin.2015.01.032.
• [20]Ozaki Y,Kitabata H,Takahata M,et al.Intracoronary nearinfrared spectroscopy to predict no-reflow phenomenon during percutaneous coronary intervention in acute coronary syndrome[J].Am J Cardiol,2024,219:17-24.DOI:10.1016/j.amjcard.2024.03.009.
• [21]Terada K,Wakana N,Kubo T,et al.Clinical outcomes of acute myocardial infarction arising from non-lipid-rich plaque determined by NIRS-IVUS[J].Sci Rep,2023,13(1):11544.DOI:10.1038/s41598-023-38578-9.
• [22]Ho soda H,Kataoka Y,Nicholls SJ,et al.Calcified plaque harboring lipidic materials as sociates with no-reflow phenomenon after PCI in stable CAD[J].Int J Cardiovasc Imaging,2023,39(10):1927-1941.DOI:10.1007/s10554-023-02905-y.
• [23]Oemrawsingh RM,Cheng JM,Garcia-Garcia HM,et al.Nearinfrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease[J].J Am Coll Cardiol,2014,64(23):2510-2518.DOI:10.1016/j.jacc.2014.07.998.
• [24]Schuurman AS,Vroegindewey M,Kardys I,et al.Nearinfrared spectroscopy-derived lipid core burden index predicts adverse cardiovascular outcome in patients with coronary artery disease during long-term follow-up[J].Eur Heart J,2018,39(4):295-302.DOI:10.1093/eurheartj/ehx247.
• [25]Waksman R,Di Mario C,Torguson R,et al.Identification of patients and plaques vulnerable to future coronary events with near-infrared spectroscopy intravascular ultrasound imaging:a prospective,cohort study[J].Lancet,2019,394(10209):1629-1637.DOI:10.1016/S0140-6736(19)31794-5.
• [26]Erlinge D,Maehara A,Ben-Yehuda O,et al.Identification of vulnerable plaques and patients by intracoronary near-infraredspectroscopy and ultrasound(PROSPECTⅡ):a prospective natural history study[J].Lancet,2021,397(10278):985-995.DOI:10.1016/S0140-6736(21)00249-X.
• [27]Kini AS,Baber U,Kovacic JC,et al.Changes in plaque lipid content after short-term intensive versus standard statin therapy:the YELLOW trial(reduction in yellow plaque by aggressive lipid-lowering therapy)[J].J Am Coll Cardiol,2013,62(1):21-29.DOI:10.1016/j.jacc.2013.03.058.
• [28]Oemrawsingh RM,Garcia-Garcia HM,van Geuns RJ,et al.Integrated Biomarker and Imaging Study 3(IBIS-3)to assess the ability of rosuvastatin to decrease necrotic core in coronary arteries[J].Euro Intervention,2016,12(6):734-739.DOI:10.4244/EIJV12I6A118.
• [29]Oh PC,Jang AY,Ha K,et al.Effect of Atorvastatin(10 mg)and Ezetimibe(10 mg)combination compared to Atorvastatin(40 mg)alone on coronary atherosclerosis[J].Am J Cardiol,2021,154:22-28.DOI:10.1016/j.amjcard.2021.05.039.
• [30]Omori H,Ota H,Hara M,et al.Effect of PCSK-9 inhibitors on lipid-rich vulnerable coronary plaque assessed by near-infrared spectroscopy[J].JACC Cardiovasc Imaging,2020,13(7):1639-1641.DOI:10.1016/j.jcmg.2020.02.019.
• [31]Ota H,Omori H,Kawasaki M,et al.Clinical impact of PCSK9inhibitor on stabilization and regression of lipid-rich coronary plaques:a near-infrared spectroscopy study[J].Eur Heart J Cardiovasc Imaging,2022,23(2):217-228.DOI:10.1093/ehjci/jeab034.
• [32]Kataoka T,Morishita T,Uzui H,et al.Very short-term effects of a single dose of a proprotein convertase subtilisin/kexin 9inhibitor before percutaneous coronary intervention:a singlearm study[J].Atherosclerosis,2024,399:118581.DOI:10.1016/j.atherosclero sis.2024.118581.
• [33]Trusinskis K,Kokina B,Lapsovs M,et al.Role of bailout gene-silencing therapy in plaque lipid reduction:intravascular imaging study[J].Cardiology,2025:1-10.DOI:10.1159/000543463.
• [34]Stone GW,Maehara A,Ali ZA,et al.Percutaneous coronary intervention for vulnerable coronary atherosclerotic plaque[J].J Am Coll Cardiol,2020,76(20):2289-2301.DOI:10.1016/j.jacc.2020.09.547.
• [35]Yamamoto MH,Maehara A,Stone GW,et al.2-year outcomes after stenting of lipid-rich and nonrich coronary plaques[J].J Am Coll Cardiol,2020,75(12):1371-1382.DOI:10.1016/j.jacc.2020.01.044.
• [36]Park SJ,Ahn JM,Kang DY,et al.Preventive percutaneous coronary intervention versus optimal medical therapy alone for the treatment of vulnerable atherosclerotic coronary plaques(PREVENT):a multicentre,open-label,randomised controlled trial[J].Lancet,2024,403(10438):1753-1765.
• [37]van Veelen A,Kü?ük IT,Fuentes FH,et al.First-in-human drug-eluting balloon treatment of vulnerable lipid-rich plaques:Rationale and design of the DEBuT-LRP study[J].J Clin Med,2023,12(18):5807.DOI:10.3390/jcm12185807.
• [38]Ali ZA,Dager A,Zú?iga M,et al.First-in-human experience with a novel multimodality DeepOCT-NIRS intracoronary imaging system[J].J Soc Cardiovasc Angiogr Interv,2024,3(4):101344,DOI:10.1016/j.jscai.2024.101344.
• [39]Ota H,Matsuo H,Imai S,et al.Multimodality imaging to identify lipid-rich coronary plaques and predict periprocedural myocardial injury:association between near-infrared spectroscopy and coronary computed tomography angiography[J].Front Cardiovasc Med,2023,10:1127121.DOI:10.3 389/fcvm.2023.1127121.
• [40]Irie D,Matsumoto H,Isodono K,et al.Complementary roles of near-infrared spectroscopy and intravascular ultrasound in the prediction of periprocedural myocardial injury[J].Can J Cardiol,2023,39(11):1502-1509.DOI:10.1016/j.cjca.2023.06.005.
• [41]Mach F,Baigent C,Catapano AL,et al.2019 ESC/EAS Guidelines for the management of dyslipidaemias:lipid modification to reduce cardiovascular risk[J].Eur Heart J,2020,41(1):111-188.DOI:10.1093/eurheartj/ehz455.
• [42]Suzuki N,Yokoi T,Kimura T,et al.Risk factors for vulnerable plaque detected using near-infrared spectroscopy in patients receiving statin therapy with no history of coronary artery disease[J].Int Heart J,2023,64(4):577-583.DOI:10.1536/ihj.23-011.
• [43]Wright RS,Ray KK,Raal FJ,et al.Pooled patient-level analysis of inclisiran trials in patients with familial hypercholesterolemia or atherosclerosis[J].J Am Coll Cardiol,2021,77(9):1182-1193.DOI:10.1016/j.j acc.2020.12.058.
• [44]van Veelen A,van der Sangen NMR,Delewi R,et al.Detection of vulnerable coronary plaques using invasive and non-invasive imaging modalities[J].J Clin Med,2022,11(5):1361.DOI:10.3390/jcm11051361.
• [45]Stone GW,Maehara A,Lansky AJ,et al.A prospective naturalhistory study of coronary atherosclerosis[J].N Engl J Med,2011,364(3):226-235.DOI:10.1056/NEJMoa1002358.
• [46]Hanson ID,Goldstein JA,Dixon SR,et al.Comparison of coronary artery lesion length by NIRS-IVUS versus angiography alone[J].Coron Artery D is,2015,26(6):484-489.DOI:10.1097/MCA.0000000000000263.
• [47]Muller J,Madder R.OCT-NIRS imaging for detection of coronary plaque structure and vulnerability[J].Front Cardiovasc Med,2020,7:90.DOI:10.3389/fcvm.2020.00090.