杨泉,卢成志,田云朋

• 1:北京大学国际医院心血管内科
• 2:天津市第一中心医院心内科

摘要(Abstract)：

目的分析冠状动脉瘤样病变的冠状动脉造影及血管内超声特点,并评价经皮冠状动脉介入治疗(PCI)与药物治疗的效果。方法纳入天津市第一中心医院2007年10月至2014年10月同时具有冠状动脉造影和血管内超声检查资料的65例冠状动脉瘤样病变患者,根据血管内超声特点分为真性冠状动脉瘤组(32例)和假性冠状动脉瘤组(33例),分析两组患者冠状动脉造影及血管内超声特点,根据狭窄程度对患者分别行PCI和药物治疗。观察两组患者主要不良心血管事件的发生情况。结果真性动脉瘤组动脉瘤在前降支比例(40.6%比75.8%,P=0.026)显著低于假性动脉瘤组,差异有统计学意义;与假性动脉瘤组相比,真性动脉瘤组瘤体长度更长[(5.9±2.7)mm比(11.1±5.8)mm,P<0.001]、瘤体中心处管腔横截面积更大[(17.7±6.6)mm2比(25.6±10.7)mm2,P=0.001]、瘤体最大直径更长[(5.3±1.0)mm比(6.2±1.5)mm,P=0.005]、瘤体中心处外弹力膜横截面积更大[(25.8±7.9)mm2比(33.5±12.0)mm2,P=0.003]、重塑指数更大[(1.6±0.4)比(2.0±0.7),P=0.008],差异均有统计学意义;而瘤体中心处斑块负荷[(32.4±10.7)%比(23.0±9.8)%,P=0.001]、近端参考血管处斑块负荷[(42.6±4.1)%比(35.1±12.1)%,P=0.024]更小,差异亦均有统计学意义。两组患者药物保守治疗及PCI情况比较,差异均无统计学意义(均P>0.05),但真性动脉瘤组横跨支架比例显著低于假性动脉瘤组(6.2%比33.3%,P=0.006),差异有统计学意义。两组患者均无心源性死亡、急性心肌梗死发生,真性动脉瘤组1例患者发生亚急性支架内血栓形成,再次PCI后好转。结论血管内超声能更好地区分真性、假性冠状动脉瘤,大部分冠状动脉瘤邻近动脉粥样硬化斑块和血管分支,提示血流动力学变化可能与冠状动脉瘤的形成有关。对冠状动脉瘤进行充分的长期抗血栓治疗,对冠状动脉瘤瘤体一侧的严重狭窄病变采用必要性PCI是合理的。

关键词(KeyWords)： 冠状动脉瘤;经皮冠状动脉介入治疗;血管内超声

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 杨泉,卢成志,田云朋

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