急性冠脉综合症及稳定心绞痛患者罪犯病变之前冠状动脉斑块的病理特点

摘要

Objective:Early diagnosis on unstable plaque is very important for preventing acute coronary events. Currently, intravascular ultrasound (IVUS) has been clinically used to analysis coronary plaque. Method:91 patients including 48 patients with acute coronary syndrome (ACS) and 43 patients with stable angina pectoris (SAP), were included, and non-crime vessel with a stenosis less than 50% in these patients were assessed by IVUS. Results:Comparison with patients with SAP, patients with ACS had higher calcification scores(7.86%±1.0%vs 4.9%±0.9%,P=0.03), necrosis cores(13.6%±1.1% vs 8.4%±1.1%,P=0.001), and thin cap atheromatous plaque (63.5%versus 34.8%,P=0.007). In addition, C-reactive protein levels of thin cap atheromatous plaque in patients with ACS is higher than those in SAP (7.96±2.56 mg/l vs 1.65±0.35mg/l,P=0.005). Conclusion:Patients with ACS had higher thin cap atheromatous plaque and C-reactive protein levels.%目的：早期识别不稳定斑块对于预防急性冠脉事件非常重要。目前使用先进的虚拟组织学冠状动脉内超声来研究冠状动脉斑块组分，并研究冠心病临床表现与非罪犯血管节段的斑块组分的临床联系。方法：对91例患者实施了虚拟冠状动脉内超声检查，检查的血管是狭窄小于50%的非罪犯病变的血管节段，其中，48例急性冠脉综合症患者，43例稳定心绞痛患者。结果：急性冠脉综合症患者组较稳定心绞痛患者组有着较高的钙化成分（7.86%±1.0%vs 4.9%±0.9%，P=0.03）和较高的坏死核心成分（13.6%±1.1%vs 8.4%±1.1%，P=0.001）。急性冠脉综合症患者组较稳定心绞痛患者组有着较高的薄帽纤维粥瘤（VH-TCFA）检出率（63.5%versus 34.8%，P=0.007）。在急性冠脉综合症患者中，检出薄帽纤维粥瘤（VH-TCFA）的患者的高敏C反应蛋白水平高于未检出薄帽纤维粥瘤（VH-TCFA）的患者（7.96±2.56mg/l vs 1.65±0.35mg/l，P=0.005）。结论：在非罪犯病变的冠状动脉节段，急性冠脉综合症患者组有着较高的薄帽纤维粥瘤（VH-TCFA）的发生率。在急性冠脉综合症中，检出薄帽纤维粥瘤（VH-TCFA）往往伴随有较高的高敏C反应蛋白水平。