来晏,姚义安,罗裕,李纪明,汪云开,汤佳旎,耿亮,刘学波

• 1:同济大学附属东方医院心内科

摘要(Abstract)：

目的观察冠心病患者靶病变钙化的特征,并比较不同临床类型之间的差异。方法连续入选2011年11月至2012年12月于东方医院心内科行冠状动脉造影和血管内超声检查的171例冠心病患者,其中稳定型心绞痛(SAP)30例(SAP组),急性冠状动脉综合征(ACS)141例(ACS组),分析靶病变的钙化类型、分布和长度。结果冠状动脉造影发现,钙化患者48例(28.1%),而IVUS发现钙化患者为122例(71.3%)。按照造影来进行钙化程度的分组,使用IVUS测量的病变长度及斑块负荷,重度钙化组明显大于无或轻度钙化组,且有统计学意义[病变长度:(27.7±12.0)mm比(17.4±8.7)mm,P<0.01;斑块负荷:(70.8±8.1)%比(67.2±7.0)%,P<0.05],而重度钙化组和中度钙化组差异无统计学意义。三组间靶病变外弹力膜面积(EEM-CSA)及最小管腔面积(MLA)差异则无统计学意义。IVUS测定的钙化长度和最大钙化弧度,三组间差异有统计学意义,重度钙化组病变的钙化长度及最大钙化弧度大于其他两组(P<0.05)。SAP组和ACS组之间,在EEM-CSA、MLA、斑块负荷及钙化的发生率方面,差异无统计学意义。但SAP组浅表性钙化与弥漫性钙化的发生率明显高于ACS组,而ACS组深部或混合钙化、点状钙化明显高于SAP组(P均<0.05)。两组最大钙化弧度均值差异无统计学意义,但ACS组病变最大钙化弧度小于90°者高于SAP组(47.5%比26.1%,P<0.05);SAP组钙化弧度在90°以上者高于ACS组(73.9%比52.5%,P<0.05),以上结果ACS的不稳定斑块钙化程度尤其在横断面分布程度低于SAP的靶病变。ACS组IVUS检出存在斑块破裂的18例患者中,17例(94.4%)为点状钙化或混合钙化;ACS组未观察到斑块破裂且存在钙化的81例患者中,点状钙化的发生率仅为45例(55.6%),两组差异具有统计学意义(P<0.01)。结论 IVUS对检出钙化的敏感性远高于冠状动脉造影。与SAP相比,ACS患者靶病变钙化弧度小、深部多见,存在斑块破裂的病变以点状钙化为主。

关键词(KeyWords)： 血管内超声;钙化;稳定型心绞痛;急性冠状动脉综合征;斑块破裂

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 来晏,姚义安,罗裕,李纪明,汪云开,汤佳旎,耿亮,刘学波

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