吴玺,黄河,张琪周,谭国娇

• 1:湖南省湘潭市中心医院心内科

摘要(Abstract)：

目的探讨稳定型心绞痛患者冠状动脉慢性完全闭塞(CTO)病变斑块虚拟组织学-血管内超声(VH-IVUS)的特征。方法回顾性研究2015年8月至2018年6月在湘潭市中心医院心内科住院行VH-IVUS分析的95例稳定型心绞痛患者,其中40例为CTO病变患者作为CTO组,55例为非CTO病变患者作为非CTO组。比较两组患者的基线资料和病变VH-IVUS特点。结果 CTO组患者病变近端参考截面的管腔面积[(7.30±1.83)mm2比(9.93±5.87)mm2,P=0.008]、病变远端参考截面的管腔面积[(5.16±1.76)mm2比(7.12±4.19)mm2,P=0.006]均显著小于非CTO组患者。使用VHIVUS测量两组的病变长度发现,CTO组患者病变长度明显长于非CTO组患者[(19.63±5.34)mm比(15.78±7.99)mm,P=0.010]。CTO组患者经球囊扩张后的病变血管最小管腔面积与非CTO组患者比较[(4.14±1.61)mm2比(4.37±1.47)mm2,P=0.871],差异无统计学意义。两组患者在病变血管最小管腔截面的血管重构指数、斑块面积、斑块负荷、斑块组成及其所占比例比较,差异均无统计学意义(均P>0.05)。CTO组患者病变近端斑块负荷[(50.35±14.83)%比(40.44±12.32)%,P=0.001]、远端斑块负荷[(43.65±12.20)%比(39.02±8.20)%,P=0.036)]均显著大于非CTO组患者。CTO组患者病变总体纤维组织体积[(65.98±13.59)mm3比(55.25±14.89)mm3, P<0.001]、钙化组织体积[(9.40±3.18)mm3比(5.58±2.77)mm3, P<0.001]、坏死核体积[(18.60±6.19) mm3比(15.51±5.73)mm3, P=0.014]均显著高于非CTO组患者,差异均有统计学意义。通过病变长度校正后,比较两组患者斑块病理组织体积发现,每毫米纤维组织、每毫米纤维脂质组织、每毫米钙化组织和每毫米坏死核体积比较,存在一定的差别,但差异均无统计学意义。结论在稳定型心绞痛患者中,与非CTO病变相比,CTO病变长度更长并且斑块负荷更重。通过病变长度校正后,CTO病变与非CTO病变的病理组织构成比例大致相同。

关键词(KeyWords)： 血管内超声;虚拟组织学;稳定型心绞痛;冠状动脉慢性完全闭塞

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 吴玺,黄河,张琪周,谭国娇

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