王泉,黄河,吉港,谭国骄,蔡鑫宇,颜燕,宋婧

• 1:南华大学衡阳医学院湘潭市中心医院研究生协作培养基地
• 2:湘潭市中心医院心血管内科

摘要(Abstract)：

目的 紫杉醇药物涂层球囊（PCB）血管成形术治疗冠状动脉原位病变的部分患者可出现晚期管腔扩大（LLE），初步了解LLE的发生机制、预测因素以及对患者生命质量的影响。方法 回顾性分析2017年6月至2021年6月在湘潭市中心医院接受血管内超声（IVUS）指导下，PCB血管成形术治疗并进行后续IVUS随访检查的冠状动脉原位病变患者69例。按随访结果是否出现LLE，分成LLE组与非LLE组。比较两组患者基线资料，手术过程，术前、随访时的西雅图心绞痛量表（SAQ）评分，术前、术后即刻、随访时IVUS检查测量结果，初步了解LLE的发生机制、预测因素以及对患者生命质量的影响。结果 随访观察发现LLE组（33例）较非LLE组（36例）有更多的血管正向重构（78.79%比25.00%,P<0.001）、夹层皮瓣愈合（63.64%比27.78%,P=0.003）、斑块消退（57.58%比19.44%,P=0.001）、剥离夹层皮瓣消退（54.55%比25.00%,P=0.012），差异均有统计学意义。多因素Logistic回归分析结果显示，夹层分型、夹层深度、冠状动脉病变分型与LLE相关，其中夹层分型组以无夹层为参照，B型夹层发生LLE是无夹层的11.992倍（OR 11.992,95%CI 1.756～81.890,P=0.011）；冠状动脉病变分型组中以C型病变为参照，冠状动脉A型病变发生LLE为C型病变的19.680倍（OR 19.680,95%CI 1.658～233.603,P=0.039）；夹层深度组以无夹层为参照，中膜夹层发生LLE是无夹层的31.496倍（OR 31.496,95%CI 4.203～236.001,P=0.001）。两组患者SAQ各维度评分组内比较，随访时的评分均高于术前评分，差异均有统计学意义（均P<0.05）。LLE组与非LLE组术前各项目评分比较，差异均无统计学意义（均P>0.05）；随访比较，LLE组各项目评分均高于非LLE组，差异均有统计学意义（均P<0.05）。结论 PCB血管成形术治疗冠状动脉原位病变后的IVUS观察发现，血管正向重构、夹层皮瓣愈合、斑块消退、夹层皮瓣消退可能是LLE的发生机制。而中膜夹层、B型夹层和A型病变可能是LLE的预测因素。LLE的出现对改善患者的生命质量可能有一定帮助。

关键词(KeyWords)： 紫杉醇药物涂层球囊;冠状动脉原位病变;晚期管腔扩大;血管内超声

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王泉,黄河,吉港,谭国骄,蔡鑫宇,颜燕,宋婧

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