范例,陈启稚,韩志华,卓杨,胡靖超,曾华甦,殷兆芳,许左隽,王长谦

• 1:上海交通大学医学院附属第九人民医院心内科

摘要(Abstract)：

目的在冠心病患者中应用光学相干断层成像(OCT)评估分层斑块并探讨其与冠状动脉易损性的关系。方法入选2017年6月至2020年12月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病的患者222例。入院后行冠状动脉造影,并对靶血管行OCT检查。记录患者的一般资料、既往病史、心血管用药史、临床生化指标以及OCT数据。结果共入选222例冠心病患者,OCT提示109例(49.1%)靶血管见分层斑块,其中左前降支61例(56.0%)、左回旋支20例(18.3%)、右冠状动脉28例(25.7%)。心肌梗死患者中分层斑块占比65.0%(39/60),不稳定型心绞痛患者中分层斑块占比44.6%(25/56),稳定型心绞痛患者中分层斑块占比42.5%(45/106)。两组患者生化指标比较,分层斑块组小而密低密度脂蛋白胆固醇[(1.16±0.38)mmol/L比(0.99±0.45)mmol/L]、肌钙蛋白[(2.69±11.57)ng/ml比(1.18±9.06)ng/ml]均高于非分层斑块组,差异均有统计学意义(均P<0.05)。靶血管OCT特征方面,与非分层斑块组比较,分层斑块组最小管腔面积更小[(2.37±1.31)mm~2比(3.35±2.23)mm~2]、面积狭窄率更大[(69.11±12.26)%比(59.41±17.12)%]、病变长度更长[(20.05±8.94)mm比(17.03±7.75)mm]、脂质斑块弧度更大[(250.33±88.02)°比(181.55±115.71)°]、脂质斑块更长[(17.13±8.78)mm比(11.28±8.52)mm]、纤维帽更薄[(49.04±19.32)μm比(61.21±9.12)μm],差异均有统计学意义(均P<0.05)。分层斑块组血栓形成、斑块破裂、巨噬细胞、微血管化、胆固醇结晶、内膜溃疡、内膜夹层、钙化斑块、薄纤维帽脂质斑块例数均较非分层斑块组更多,差异均有统计学意义(均P<0.05)。受试者工作特征曲线显示,脂质斑块弧度预测分层斑块的曲线下面积(AUC)为0.683,敏感度为87.2%,特异度为43.4%,诊断临界值为167°(P<0.001);脂质斑块长度预测分层斑块的AUC为0.688,敏感度为77.1%,特异度为54.0%,诊断临界值为11.8 mm(P<0.001)。非分层斑块组和分层斑块组9个月累计主要不良心血管事件发生率比较,差异有统计学意义(P=0.038),分层斑块组累计发生的MACE较多。结论分层斑块不仅反映既往有斑块破裂或血栓形成的愈合史,还反映脂质斑块易损性,可能有预测未来冠状动脉事件潜在风险的价值。

关键词(KeyWords)： 光学相干断层成像;分层斑块;薄纤维帽脂质斑块;脂质斑块

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 范例,陈启稚,韩志华,卓杨,胡靖超,曾华甦,殷兆芳,许左隽,王长谦

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