刘传芬,刘健,卢明瑜,马玉良,赵红,李琪,王伟民

• 1:北京大学人民医院心脏中心

摘要(Abstract)：

目的探讨性别差异是否影响急性冠脉综合征(ACS)患者的动脉粥样硬化斑块的负荷和性质。方法对81例ACS患者的81处病变进行血管内超声(IVUS)检查,其中男性60例,女性21例,分析病变的狭窄程度及粥样硬化斑块性质,比较男女两组是否存在差异。结果男性患者的吸烟比例高于女性(80.0%比4.8%,P<0.05)。两组患者的病变支数和罪犯血管差异无统计学意义。女性患者在病变处的最小管腔面积(MLA)[(3.45±1.39)mm2比(3.85±2.55)mm2]、外弹力膜面积(EEM)[(13.73±5.00)mm2比(15.28±6.53)mm2]、斑块面积[(10.27±4.86)mm2比(12.01±5.21)mm2]和斑块负荷[(0.73±0.11)比(0.81±0.11)]等方面小于男性患者,但差异无统计学意义。女性ACS患者的破裂斑块比例明显低于男性(23.8%比51.7%,P<0.05)。多因素分析显示,吸烟是斑块破裂的危险因素(OR 3.874,95%CI:1.602～10.703)。结论 ACS患者男性的破裂斑块比例高于女性,多因素校正后吸烟是斑块破裂的危险因素。ACS患者动脉粥样硬化斑块的性别差异值得进一步探讨。

关键词(KeyWords)： 冠状动脉疾病;超声检查,介入性;性别特性

Abstract:

Keywords:

基金项目(Foundation): 北京大学人民医院研究与发展基金资助课题(RDC2011-27)

作者(Author): 刘传芬,刘健,卢明瑜,马玉良,赵红,李琪,王伟民

参考文献(References)：

• [1]Roger VL,Go AS,Lloyd-Jones DM,et al.Heart Disease andStroke Statistics 2012 Update:A Report From the AmericanHeart Association.Circulation,2012,125:e2-e220.
• [2]Vaccarino V.Ischemic Heart Disease in Women Many Questions,Few Facts.Circ Cardiovasc Qual Outcomes,2010,3:111-115.
• [3]Wenger NK.Women and Coronary Heart Disease:A CenturyAfter Herrick:Understudied,Underdiagnosed,andUndertreated.Circulation,2012,126:604-611.
• [4]The TIMI Study Group.The Thrombolysis in MyocardialInfarction(TIMI)trial.N Engl J Med,1985,312:932-936.
• [5]Mintz GS,Nissen SE,Anderson WD,et al.American College ofCardiology clinical expert consensus document on standards foracquisition,measurement and reporting of intravascularultrasound studies(IVUS).A report of the American College ofCardiology Task Force on Clinical Expert Consensus Documents.JAm Coll Cardiol,2001,37:1478-1492.
• [6]Thygesen K,Alpert JS,Jaffeet AS,et al.Universal definition ofmyocardial infarction.Circulation,2012,126:2020-2035.
• [7]Wright RS,Anderson JL,Adams CD,et al.2011 ACCF/AHAFocused Update of the Guidelines for the Management of PatientsWith Unstable Angina/Non ST-Elevation Myocardial Infarction(Updating the 2007 Guideline):A Report of the AmericanCollege of Cardiology Foundation/American Heart AssociationTask Force on Practice Guidelines.Circulation,2007,116:e148-e304.
• [8]Bugiardini R,Bairey Merz CN.Angina with″normal″coronaryarteries:a changing philosophy.JAMA,2005,293:477-484.
• [9]Sharaf BL,Pepine CJ,Kerensky RA,et al.Detailedangiographic analysis of women with suspected ischemic chestpain(pilot phase data from the NHLBI-sponsored Women'sIschemia Syndrome Evaluation[WISE]study angiographic corelaboratory).Am J Cardiol,2001,87:937-941.
• [10]Nicholls SJ,Wolski K,Sipahi I,et al.Rate of progression ofcoronary atherosclerotic plaque in women.J Am Coll Cardiol,2007,49:1546-1551.
• [11]Lansky AJ,Ng VG,Maehara A,et al.Gender and the extent ofcoronary atherosclerosis,plaque composition,and clinicaloutcomes in acute coronary syndromes.J Am Coll Cardiol Img,2012,5:S62-S72.
• [12]Virmani R,Burke AP,Kolodgie FD,et al.Pathology of the thin-cap fibroatheroma:a type of vulnerable plaque.J Interv Cardiol,2003,16:267-272.
• [13]Virmani R,Kolodgie FD,Burke AP,et al.Lessons from suddencoronary death:a comprehensive morphological classificationscheme for atherosclerotic lesions.Arterioscler Thromb VascBiol,2000,20:1262-1275.
• [14]刘峰,王炳银.冠状动脉易损斑块的研究进展.中国介入心脏病学杂志,2012,20:171-174.
• [15]Hong MK,Mintz GS,Lee CW,et al.Comparison of coronaryplaque rupture between stable angina and acute myocardialinfarction:a three-vessel intravascular ultrasound study in 235patients.Circulation,2004,110:928-933.
• [16]Maehara A,Mintz GS,Bui AB,et al.Morphologic andangiographic features of coronary plaque rupture detected byintravascular ultrasound.J Am Coll Cardiol,2002,40:904-910.
• [17]Cheruvu PK,Finn AV,Gardner C,et al.Frequency anddistribution of thincap fibroatheroma and ruptured plaques inhuman coronary arteries:a pathologic study.J Am Coll Cardiol,2007,50:940-949.
• [18]Kramer MC,Rittersma SZ,de Winter RJ,et al.Relationship ofthrombus healing to underlying plaque morphology in suddencoronary death.J Am Coll Cardiol,2010,55:122-132.